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LIBRARY OF CONGRESS. 11 



Shelf xJjirfip^ 

UNITED STATES OF AMERICA. 



MAXIMS OF 



PUBLIC HEALTH. 



- "/ BY 

0. W. WIGHT, A. M.,M.D., 

HEALTH OFFICER OF DETROIT. 




NEW TOEK: 

D. APPLETON AND COMPANY, 

1, 8, and 5 BOND STEEET. 

1884. 



~~t^> 







Copyright, 1884, 
By D. APPLETON AND COMPANY. 



PKEFACE 



I will try, as clearly as possible, to give some gen- 
eral notion of what this book contains. 

I have written for the people, rather than for sani- 
tarians ; for laymen, rather than for the medical pro- 
fession. Yet the weary, perhaps discouraged, health- 
officer may find herein a stimulus to effort and a con- 
diment to more substantial hygienic food ; and the 
busy practitioner of medicine may glean needful in- 
formation more easily than from the ponderous trea- 
tises in which, it is to be hoped, his library abounds. 
The intelligent householder who has no time, probably 
no inclination, for systematic studies, may read here- 
in, as he runs, and find hints that will save himself 
and his loved ones from unspeakable pain and sorrow. 
John Simon, the prince of sanitarians, says: "Two 
gigantic evils stand conspicuous : first, the omission 
(whether through neglect or through want of skill) to 
make the due removal of refuse matters, solid and 
liquid, from inhabited places ; and, secondly, the li- 
cense which is permitted to cases of dangerous infec- 
tious diseases to scatter abroad the seeds of their in- 



4 PREFACE. 

fection. In certain very important cases, injury — 
immense injury — accruing to the public health, arises 
from a co-operation of these two evils ; arises, namely, 
through the special facility which certain forms of 
local uncleanliness provide for the spreading of certain 
specific infections ; and the influence which unclean- 
liness almost necessarily exerts in that way against 
the public health makes so large an addition to the 
influence which it exerts in other ways, that, in total 
power, uncleanliness must, I think, without doubt, be 
reckoned as the deadliest of our present removable 
causes of disease." - 

The plague, Asiatic cholera, typhus fever, typhoid 
fever, diphtheria, scarlatina, yellow fever, small-pox, 
and some other infectious diseases belong to the same 
class. The plague, that has frequently decimated 
mankind, still lingers in an endemic form among the 
haunts of misery, want, ignorance, and degeneracy of 
race. It leaps from its lair when unobstructed, and 
invades the homes of the intelligent and well-to^do 
classes by infection. It has been declared, by the 
perversity, the ignorance, the assumption, or some- 
thing worse, of a small but noisy and persistent part 
of the medical profession, to be non-infectious, and 
has been left to spread and destroy mankind. It was 
regarded in former times as a mysterious visitation of 
Divine Providence, and consequently no measures 
were taken to arrest its course. Other diseases, now 
more prevalent, are regarded by many in the same 
light, and therefore the sanitarian of to-day has to 
deal with the stubborn apathy of superstition. 



PREFACE. 5 

Typhus fever is nearest of kin to the plague. 
"While it persists in the midst of poverty, filth, and 
overcrowding in the Old World, it has fortunately 
never prevailed to any great extent in our American 
centers of population. Typhoid fever is a member 
of the same family, and is too well known in all 
lands. Malignant cholera is a "tramp" from the 
same epidemic family, but has fortunately been great- 
ly restricted in its wanderings by a more intelligent 
quarantine and by increased cleanliness. Yellow fever 
is first cousin to the plague, and will continue to deso- 
late certain portions of this country till our Southern 
cities practice sanitation better, and the Federal Gov- 
ernment undertakes the duty of preventing its periodic 
importation. Diphtheria, like the plague, feeds on 
filth and is propagated by infection. Scarlatina is 
the more fervid, but not less malignant, sister of diph- 
theria. Both knock at our doors with murderous 
hands, and will not leave till sanitary administration 
is allowed to enforce with more vigor the isolation 
and cleanliness taught by advancing sanitary science. 
Small-pox is the " Wandering Jew" of the epidemic 
family ; but human ingenuity has tamed its destruc- 
tive spirit with the cunning of vaccination. Here, 
again, cleanliness and isolation can do the rest. 

It can not too often be repeated : the whole family 
of the epidemic foes of mankind can be banished by 
isolation and cleanliness. The coarser plague goes 
first ; then, one after another, the rest. And, by the 
same means, the other conditions of health and well- 
being will be greatly improved. Therein, as Simon 



6 PREFACE. 

nobly says, lies the chief work of sanitation. The 
greater portions of this book are devoted to the prac- 
tical problems of combating infectious diseases and the 
removal of the filth-conditions in the midst of which 
they flourish. The profession and the public must 
be educated to appreciate the necessity of using the 
best methods. 

All the diseases belonging to the epidemic family 
are not discussed in detail. Diphtheria, scarlatina, 
cholera, small-pox, and others that are prevalent in 
this latitude, have received careful attention. Of 
course, discussions of these diseases have been limited 
to considerations of preventive measures. The field 
of curative medicine has not been invaded. Adminis- 
trative, as well as sanitary, methods of combating 
contagious maladies have been presented with the 
fullness and earnestness demanded by an awfully im- 
portant subject. 

I have not contented myself with urging the re- . 
moval of filth, but have given recommendations which, 
if followed, will prevent the existence of filth within 
inhabited areas. The abundant organic wastes result- 
ing from our household and manufacturing life are 
soon transformed into filth by putrefactive decay. 
With all the energy I could command I have advo- 
cated the removal of such wastes before their trans- 
formation into filth, and have pointed out the ways 
whereby it can be done. The problem of removing 
from human habitations matters manufactured by 
decay into filth-poison involves grave questions of 
sewering towns, draining inhabited places, plumbing 



PREFACE. 7 

houses, etc. The principles that must be followed 
to prevent accumulations of filth have been herein 
much more amply discussed than mechanical appli- 
ances and engineering devices. The only way to get rid 
of sewer-gas is not to make any. The only way to avoid 
filth, in gaseous, liquid, or solid form, is to leave noth- 
ing around, even for an hour, to putrefy. All the 
infectious diseases are nourished, if not created, by 
putrefactive decay. Sanitary engineering is behind 
science, behind enlightened public demand, when it 
neglects preventive methods. 

Growing out of discussions of the two great evils 
of uncleanliness and infection, so graphically stated 
by Mr. Simon, arise considerations of the germ-theory 
of disease. Avoiding dogmatism, making no preten- 
sion to original views, I have simply endeavored, by 
various forms of statement, explanation, and illustra- 
tion, to make clear to the non-scientific mind what is 
meant by the term. The subject recurs in connec- 
tion with various topics. 

The subject of "offensive trades," technically so 
called, is treated, here and there, not fully enough for 
the guidance of a board of health in its administrative 
work, but sufficiently to teach the citizen his common- 
law rights to enjoy a reasonably quiet and healthy 
home. Some points of the law of nuisance are given, 
for the purpose of pointing out to suffering people 
the proper method of redress in places where no sani- 
tary authority has been established by State or mu- 
nicipal enactments. 

Many things have been touched, some with a 



8 PREFACE. 

gentler, some "with a firmer hand, which need not he 
enumerated here. 

I have given the results of six years of personal ex- 
perience in sanitary administration, in a somewhat 
desultory form, dwelling most upon those things that 
are practically of greatest importance, and least upon 
those things that are purely speculative. The reader, 
in order to find all that has heen said upon any sub- 
ject, will need to consult the index. This is not a 
systematic treatise. Sequence is in some measure 
wanting. The sections are numbered, but have no 
other heading. Conclusions, not processes, have been 
given. The concrete method has been preferred to 
the analytical, as better adapted to minds not trained 
to scientific investigation. In short, I have attempted 
to make gravely important sanitary matters interest- 
ing as literature. About the success of the attempt 
I am not over-sanguine. 

In addition to the original matter, passages in my 
reports, written and printed for local use, have been 
here reproduced, but reshaped and adapted to gen- 
eral publication. These passages, lost in a mass of 
statistics and special discussions of municipal meas- 
ures, are really new to the public. 

May this little "ounce of prevention" save, for 
some, many "pounds of cure." 

0. W, Wight, A.M., M.D. 

Detroit, July, 1884- 



MAXIMS OF PUBLIC HEALTH. 



" It has been proved over and over again/' says 
Dr. Parkes, ' ' that nothing is so costly in all ways as 
disease, and that nothing is so remunerative as the 
outlay which augments health, and, in doing so, aug- 
ments the amount and value of the work done." 
Playfair, whose statistics are regarded as of great 
value, tells us that there are twenty-eight cases of 
sickness to every death. Let us reduce the estimate 
to a minimum of twenty. At a low calculation, each 
case of sickness represents a loss of fifty dollars to the 
State or to the community taken as a whole. Every 
unnecessary death, and the twenty concurrent cases 
of unnecessary sickness, therefore, represent a public 
loss of one thousand dollars. In other words, the 
community is on that account so much the poorer. 
Dr. W. E. Boardman, in a careful and elaborate paper 
contributed to the " Sixth Annual Eeport of the Massa- 
chusetts State Board of Health," demonstrates that the 
annual loss to that commonwealth by preventable 



10 MAXIMS OF PUBLIC HEALTH. 

sickness is considerably more than three millions of 
dollars. The loss to the people of the United States 
thereby is not less than the interest on the national 
debt. Every dollar wisely spent for the preservation 
of the public health is returned ten-fold, sometimes a 
hundred-fold, to the community. " It is," says Dr. 
Farr, "as certain that a high mortality can be re- 
duced, by hygienic appliances, down to a certain 
limit, as it is that human life can be sacrificed. " And 
above all material saving, is the far higher considera- 
tion, the divine economy, of human suffering. "The 
hope," again says Dr. Parr, "of saving any number 
of human lives by hygienic appliances is enough to 
fire the ambition of every good man who believes in 
human progress." 

II. 

In sanitation it must not be forgotten that there 
is an immeasurable distance between organic and or- 
ganized matter. In passing from the former to the 
latter, chemistry affords us no aid. Give the chemist 
a handful of sound wheat and also an equal handful 
of ground wheat. His science can not tell the differ- 
ence between the two. The dead elements of the one 
are exactly equal, in quantity and quality, to the dead 
elements of the other. Yet, from another point of 
view, how different are the two ! The handful of 
unground wheat, the organized wheat, has within it 
the power to multiply itself, under favorable circum- 
stances, till it covers the world with harvests. The 
ground wheat may nourish an animal or a plant, or 



MAXIMS OF PUBLIC HEALTH. \\ 

it may mingle with the inert elements of the earth, 
but under no conditions can it multiply itself. You 
may give the chemist some healthy unbroken eggs and 
also some crushed eggs. As chemist, he can not dis- 
cover the difference between the two. Both furnish to 
him the same elements. Yet there is a chasm between 
them as wide as the bourne between life and death. 
The whole eggs, under favoring conditions, will hatch, 
produce animals of their kind, which may at length 
people whole continents. The broken eggs have ended 
their existence, except as lifeless matter, which may 
enter into an endless series of other forms, but they 
can never "increase and multiply." This is what 
makes the germ-theory of infectious diseases so im- 
portant. The germs, being organized matter, may 
increase, like the whole wheat or the unbroken eggs, 
in geometric ratio. No other theory can wholly ac- 
count for the devastating epidemics that rapidly sweep 
over large regions of the inhabited parts of the globe. 
Under favoring conditions of season, temperature, 
moisture, perhaps electricity, or more subtile elements, 
the germs of yellow fever, cholera, scarlet fever, the 
plague, and other zymotic diseases, that otherwise 
would remain dormant or have only a feeble growth, 
may multiply myriads and myriads of times, decimat- 
ing the population of whole nations. Then mankind 
reap the benefits arising from the absence of filth 
which nourishes above all things else the growth of 
these invisible foes of life. Then we need the resist- 
ing vigor of health that comes from cleanly habits of 
living. 



12 MAXIMS OF PUBLIC HEALTH. 

III. 

The average cost of educating a child at school — 
food, clothing, home care, tuition — all things in- 
cluded, is not less than one hundred and fifty dollars 
a year. The unsanitary conditions of school-buildings 
neutralize the work of education to the extent of at 
least one third. The foul air of unventilated and 
crowded school-rooms, the unequal heating, the poi- 
sonous sewer-gas in the outhouses or in the building, 
cause depression, loss of energy, nervous irritability, 
dullness of brain, waste of time from ill-health, which 
increase the friction and slacken the speed of educa- 
tional progress more than one third. But call the 
loss one third, which is certainly a minimum. 'Mow, 
one third of the yearly cost of one hundred and fifty 
dollars is fifty dollars. The number of children at 
school in a city of one hundred thousand inhabitants 
is about twenty thousand. The loss on the whole 
number, therefore, amounts to the enormous sum of 
one million dollars per annum. The loss falls on the 
parents of the children, distributed throughout the 
city. And this is not all. The habit of dullness, 
begotten by the unsanitary conditions of school-build- 
ings, lasts during life, and more or less cripples the 
productive energy of each generation of citizens. 
Moreover, this vital question touches the pride and 
hope of almost every household. We must reckon 
also the cost of increased sickness, and a larger per- 
centage of death. It seems heartless to dwell upon 
the economic side of such a great and important sub- 



MAXIMS OF PUBLIC HEALTH. 13 

ject. Above all, and beyond all, are human suffering, 
constitutions broken for life, seeds of disease early- 
sown, pain too deep for tears in the panting breast of 
many a little one, the heartache of parents, the shroud, 
the emblems of mourning, the solemn "dust to dust" 
and "ashes to ashes," closing blighted careers which 
sanitary wisdom might have prolonged over the cus- 
tomary years of usefulness. 



The preservation of the public health, before the 
nineteenth century, was an unknown or forgotten art 
among Christian nations. The hygienic formula of 
the -old Greek, Hippocrates, "Pure air, pure water, 
and a pure soil," was scarcely less comprehensive than 
the sanitary commands of Moses. The best modern 
science confirms the wisdom of the heathen physician, 
and not even the Hon. Eobert Ingersoll has discovered 
any sanitary mistakes made by the Hebrew lawgiver. 
The Saracens practiced temperance and cleanliness 
during the Middle Ages, and consequently suffered 
less from epidemics than the dirty and drunken 
Christians of Europe. 

The new era, in which the State assumes the guar- 
dianship of the public health, is bright with promises 
of physical good to Christian peoples. It was a great 
preacher of the gospel of Christ who declared " Cleanli- 
ness to be akin to Godliness. " Hygienic redemption 
of bodies is next in personal importance to spiritual 
redemption of souls. Fortunately, it is no longer 



14 MAXIMS OF PUBLIC HEALTH. 

fashionable in the church to mortify the flesh with 
visible or invisible vermin. The "black death" was 
not a good means of grace even in the days of Pro- 
copius, Boccaccio, or De Foe. 



The Greek brigand and revolutionist, Theodore 
Kolokotrones, speaking from bitter experience, com- 
plained in his " Memoirs " " of the suffering caused by 
the filth of long- worn garments as rivaling the pangs 
of hunger." Through several miles of sewers in the 
skin are daily eliminated from the body about thirty 
ounces, nearly two pints, of liquid waste, two and one 
half per cent of which may be reckoned as solid mat- 
ter. The excrement from the skin, when undergoing 
putrefactive decomposition, is quite as poisonous as 
the excrement from the kidneys or from the intes- 
tines. The two pints daily of excreta from the in- 
tegument of the body rapidly saturate the clothing. 
Dirty linen in an unventilated closet will soon become 
as offensive and dangerous as an unclean urinal or 
water-closet. The excrement saturating clothes worn 
too long without washing putrefies and makes the 
person offensive. This is the reason why a room filled 
with people will in a brief time smell like a charnel- 
house, if not thoroughly ventilated. The body in a 
few days will become smeared all over with the decom- 
posing waste. People will live, and eat, and sleep, go 
to church, move about the streets, frequent assemblies, 
attend parties, get into public conveyances, and oc- 



MAXIMS OF PUBLIC HEALTH. 15 

cupy their places of business, with unwashed skins, 
clothed in unwashed garments, not even suspecting 
that, from a sanitary point of view, they are as un- 
clean as the idiot who does not know enough to obey 
the calls of nature. A sponge-bath every morning is 
a necessity of decent living. We ought to be grateful 
to the Mohammedans for teaching dirty Christian Eu- 
rope to wash herself. Water from the wash-tub and 
the bath-tub belongs with sewage, and requires the same 
care in its disposal as in the disposal of the contents 
of water-closets. The Greek brigand was right : a 
dirty shirt is as bad as hunger. Mr. Emerson says 
truly that the best of us had rather eat with a washed 
sinner than with a dirty saint. 



A public sanitary conscience can be created only 
by the enactment and enforcement of wise sanitary 
laws. "I have given it as my deliberate opinion," 
says Alexander Bain, " that authority or punishment 
is the commencement of that state of mind recognized 
under the various names of conscience, the moral 
sense, the sentiment of obligation. The major part 
of every community adopt certain rules of conduct 
necessary for the common preservation of, or minis- 
tering to, the common well-being. They find it not 
merely their interest, but the very condition of their 
existence, to observe a certain number of maxims of 
self-restraint and of respect to one another's feelings 
on such points as person, property, and good name. 



16 MAXIMS OF PUBLIC HEALTH. 

Obedience must be spontaneous on the part of the 
larger number, or on those whose influence prepon- 
derates in society ; as regards the rest, compulsion 
must be brought to bear." "Compulsion must be 
brought to bear " to secure respect for health and life, 
as well as for property and good name. 



Sarcastic old Rabelais makes his hero find a book 
in the library of a convent, entitled "The Medita- 
tions of a Holy Nun in the Perils of Childbirth." A 
book, entitled " The Meditations of a Quack Midwife 
in the Act of Killing new-born Babies," might be 
profitably written, if any one could suppose that an ig- 
norant, presumptuous creature, venturing to approach 
the lying-in woman, at the sacred hour of maternity, 
with unskilled and often unclean hands, is mentally 
or morally capable of meditating at all. Educated 
midwives are a boon to the poor. Women who offer 
their services without knowledge — knowledge ascer- 
tained and certified to by a properly appoiuted pub- 
lic authority — should be treated as criminals. The 
number of " still-births " in all our mortuary records 
is fearful. Quack midwifery is among the obvious 
causes, but not the sole cause. Liberty to slaughter 
innocents seems to be quite as dear to the feminine as 
to the masculine heart. These Lucretia Borgias of 
the bed-side will in due time have a proper place in 
the history of peoples. 



MAXIMS OF PUBLIC HEALTH. 17 

VIII 

Whoever tries to live entirely by rule may end by 
not living at all. It would be a fatal mistake, how- 
ever, to take encouragement from this to live an 
irregular life. 



The house in which a man dwells is his outer 
garment. If the walls are damp, he is in the condi- 
tion of one sitting in wet clothes. Colds, rheuma- 
tism, pneumonia, consumption, and other distempers 
may come from such a source. Walls built of brick 
from the foundation are always damp. Water is car- 
ried up from the earth by capillary attraction. A 
brick will absorb a pound of water. So you may 
have as many pounds of water in the walls as there 
are bricks in the house. The remedy is simple. 
There should be a course of slate, vitrified brick, or 
asphalt, a little way up from the earth, all around. 
Stone foundations are safer than brick, yet not alto- 
gether secure. Another thing of very great impor- 
tance is connected herewith. Dry walls are pervious 
to air. By means of a properly shaped tube a candle 
may be blown out through a dry brick. As soon as 
cold weather comes, when the habit is to close win- 
dows and doors, and the fires are lighted, there will be 
an interchange of air between the outside and the in- 
side of a house through dry walls. Thus the house 
will be ventilated without draughts. In fact, this is 
the most important factor in natural ventilation. 



18 MAXIMS OF PUBLIC HEALTH. 

On the other hand, wet walls are impervious to air. 
No ventilation can take place in the manner de- 
scribed. The air, therefore, in a damp house is 
always close and foul. In it flourish all sorts of mi- 
croscopic things belonging both to the animal and 
vegetable kingdoms. Even larger and visible fungi 
flourish in a damp house. Things become "moldy," 
as we say. As all organizations that live and grow 
must decay and die, it follows that the air of a damp 
house will be more or less poisoned with dead bac- 
teria and rotting bacilli. Human life is worth a great 
deal more in a dry house than in a wet one. So 
build your habitation in a way to keep it dry. 



x. 

Oxygen is nature's favorite disinfectant. Combus- 
tion is rapid oxidation. The atmosphere is the great 
source of oxygen acting as a purifier. Foul liquids are 
rendered harmless by filtration through aerated earth. 
But it is not so much the earth that purifies as the air 
that permeates it. Underdrained land is very por- 
ous, and contains a large supply of air. In the air 
with which the pores of the earth are filled there is 
a superabundance of oxygen. The porous earth acts 
as a. sieve, which breaks up the liquid filth into fine 
particles, bringing it into contact with the oxygen of 
the contained air. All organic matters are rendered 
harmless by oxidation. Oxygen is, indeed, the most 
abundant product of nature. It constitutes about 
one half, by weight, of the earth's crust. Sand is 



MAXIMS OF PUBLIC HEALTH. 19 

more than half oxygen. It constitutes 48 per cent 
of limestone. Clay contains 50 per cent of it. It is 
89 per cent of water, in oceans, rivers, lakes, The 
atmosphere contains 23 per cent of oxygen. 

If, then, water contains so much larger a percent- 
age of oxygen than air, and organic filth is purified 
by oxygen, why does not water purify it more rapidly 
than air ? For this simple reason, that oxygen is chem- 
ically combined with hydrogen to form water, while it 
is mechanically combined with nitrogen to form air. 
In the latter, oxygen is a free agent. In the former, it 
is combined with something else. Ordinary combus- 
tion consists in union with oxygen. "Water is burnt 
hydrogen. Air is simply oxygen diluted with nitro- 
gen. Hence, the free oxygen of the atmosphere 
unites with, or burns, putrescible matters and renders 
them harmless. Still water makes a " dead bree " of 
the same matters, instead of giving up its oxygen to 
burn them. Water, when violently agitated, as in 
turbulent streams, or lakes swept by winds, contains 
some admixture of air, the free oxygen of which puri- 
fies a limited amount of filth thrown into it. 

And, in the air itself, ozone, which, according to 
Dr. De Chaumont, is an intensified oxygen with a 
greater number of atoms, is probably the most power- 
ful and rapidly destructive agent of putrefying organic 
matters. "Ozone," he says, "oxidizes (burns, in 
fact) organic matter with great rapidity, much more 
rapidly, in fact, than ordinary oxygen. In this way 
it may be considered the great scavenger of the air." 



20 MAXIMS OF PUBLIC HEALTH. 

XI. 

All matter may exist in a solid, liquid, or gaseous 
state. A whole book might be written on this sub- 
ject. As a rule, poisons are least dangerous in the 
solid form, and most dangerous in the gaseous form. 
Gases are invisible. Hence, we are often in the midst 
of unseen dangers. How few know anything about 
the gases of organic decay that frequently peryade the 
living-rooms of habitations ! Those who do know 
about them give them no heed for the most part. Out 
of sight, out of mind. Some even refuse to believe 
what they can not see. Let such wrestle with the 
whirlwind, which is only an invisible gas in violent 
motion. Touch, and smell, and hearing help out 
the imagination and assist belief. Yet deadly things 
exist which none of the unaided senses can recognize. 
The spectroscope, the microscope, and chemistry re- 
veal for us new realms. And the reasoning intellect 
builds for us ladders of science on which we labori- 
ously climb to truth, as we are carried on the wings 
of faith to the supersensual. 



The often-quoted aphorism of Franklin, " Public 
health is a nation's wealth," is a one-sided truth. 
Thrift, industry, integrity, sobriety, education, pru- 
dence, judgment, patriotism, are important factors, 
as well as health, in national prosperity. A healthy 
spendthrift can squander an inheritance quicker than 



MAXIMS OF PUBLIC HEALTH. 21 

a sickly one. A lazy invalid is not so expensive as an 
able-bodied beef -eater. A vigorous knave can appro- 
priate more of the earnings of honest people than one 
who is bed-ridden. A drunkard of physical capacity 
can waste more than a milksop. A muscular fool can 
upset more things than a feeble one. A hearty rattle- 
brains can always beat a puny one in begetting disas- 
ters. A robust crank is always more dangerous than 
one who is weakly. An athletic revolutionist can an- 
nihilate more national wealth than one who frequently 
seeks a hospital. Let us have things in proportion, 
in sanitation as elsewhere. 



In a city of considerable size, I had six acres of 
beautiful, planted ground. Close by the house was a 
well of sweet, cool, clear water. A trench, dug in the 
street, just twenty-three rods away, for the purpose 
of constructing a sewer, cut off the source, and the 
well dried up. Suppose somebody had sunk a privy- 
vault or cesspool near or over the vein of water in the 
earth supplying the well. In due time, persons drink- 
ing the water would have slowly sickened with a 
typhoid type of fever, and some of them would proba- 
bly have died. If some one infected with cholera or 
enteric fever had used the vault or cesspool, the dis- 
ease would have been conveyed through my well to 
those drinking its water. If the sewer had not cut 
off the vein, leakage from it might have caused the 
same disasters. A skilled sanitary inspector would 



22 MAXIMS OF PUBLIC HEALTH. 

have been troubled to discover the source of the poi- 
son. A well in London, the water of which was 
clear, sparkling, and pleasant to the taste, was found 
to be scattering zymotic diseases among the people in 
the neighborhood using it. A government chemist 
demonstrated that the water was impregnated with 
the products of decay in surrounding cesspools and 
grave-yards. Yet the people protested against the 
official closure of the infected well. So difficult is it 
to convert sanitary sinners ! No one should drink 
water from a well or spring within an inhabited area 
till the good time comes when the earth about human 
habitations shall no longer be polluted with vaults, 
dunghills, heaps of garbage, etc. — when all organic 
wastes shall be removed without allowing them to 
touch and defile the soil on which man lives, or infect 
the air of heaven which he breathes. In the mean 
while — and it may be a long while — if you and the 
dear ones of your household must use water thus ex- 
posed, boil it before drinking it. Nearly all disease- 
germs are killed by cooking. Never be deceived by 
the look and taste of water ; judge it also by the sur- 
roundings. 

XIV. 

In the cities of China all filth is thrown into the 
streets. It looks bad enough. It smells bad enough. 
Yet Chinese cities are remarkably free from typhoid 
fever and other filth-diseases. Why ? Simply be- 
cause in China all filth is quickly removed from the 
streets for manure. The filth is not left long enough 



MAXIMS OF PUBLIC HEALTH. 23 

to undergo putrefaction. The gas resulting from 
putrefaction contains the disease-generating poison. 
Most people suppose that fresh excrement is al- 
ready in a state of decomposition. This is not so. 
Like a dead cat, it undergoes putrefaction more or 
less swiftly according to surrounding conditions of 
temperature, moisture, etc. Sulphureted hydrogen 
is like the bark of a dog that is not very terrible for 
its bite. The gas of putrefaction is like the bite of 
a dog that gives no warning bark. Besides, filth 
putrefying in the open air is not so dangerous as filth 
putrefying in close vaults, cesspools, and badly con- 
structed sewers. A basketful of dead rats in the 
street are not half so offensive as one dead rat in the 
wall. It would be interesting to know what the 
Chinese think of our methods. There is a perilous 
journey from sanitary ignorance to sanitary science, 
from unsuspecting sanitary innocence to conscious 
sanitary virtue. 

xv. 

Stables, in cities or elsewhere, are a necessity. 
Men can not do without horses. And these faithful 
slaves of mankind must be housed. As a rule, a stable 
is a nuisance, by reason of noise and smell. A stable, 
however, need not be a nuisance. The fault is in the 
building and maintenance. The site of a stable should 
be thoroughly underdrained. The floors should be 
of concrete covered with a pavement of Bermuda 
asphalt, like the pavement in the streets of Washing- 
ton. Plank floors are noisy. Wood absorbs the urine 



24 MAXIMS OF PUBLIC HEALTH. 

of horses and becomes foul and stinking. Most stable- 
floors of plank leak, and the ground underneath be- 
comes gradually saturated with liquids undergoing 
putrefactive decomposition. Old livery-stables, the 
habitations of several scores of horses, are among the 
worst nuisances of villages and cities. Ordinances, 
statutes, and the common law afford sufferers in the 
neighborhood means of relief, if they choose to employ 
a lawyer and seek their remedy. All liquids from a 
stable, public or private, should be conveyed to a 
sewer, or other proper place, with as much care as 
the sewage from a house. Manure should not be 
thrown outside on the ground. It should be put in 
a proper box inside, kept dry, and frequently removed 
to the land. Many persons assert that the smell of 
a stable is healthy. There are dunces who think that 
the smell of a sewer or a vault is not unhealthy. The 
gases arising from the putrefactive decomposition 
of the excreta of horses are poisonous, like the 
gases arising from the decomposition of any other 
animal matter. The urine of horses contains about 
six times as much putrescible matter as the dung, and 
is therefore six times more dangerous, as well as being 
six times more valuable for manure. Horses are very 
sensitive to unsanitary conditions. Men will stand 
an atmosphere containing one part in two hundred 
and fifty of sulphureted hydrogen. Half that amount 
will sicken a horse. Veterinary surgeons in Euro- 
pean armies have recently saved a vast expenditure 
in horses by underdraining and ventilating stables. 
It costs but little more to make and maintain a sani- 



MAXIMS OF PUBLIC HEALTH. 25 

tary and noiseless stable than it does to make and 
maintain one that annoys the neighborhood with foul 
odors and reverberating sounds. The increase of ex- 
penditure will be returned manifold by the healthier 
condition of the animals. Every nuisance stable 
should be treated without toleration. The horse is 
a noble animal ; he knows more and suffers more than 
you think he does ; and you should treat him, as the 
Arab does, with tenderness and humanity, like a 
gentleman. 

XYI. 

Dr. Buchanan, in England, and Dr. Bowditch, 
in the United States, simultaneously demonstrated 
that the wetness of soil is at least the exciting cause 
of phthisis. Surface accumulations of water are not 
only inconvenient and unsightly, but also disagreeable 
and unhealthy. Subsoil dampness makes the sight 
of any habitation incompatible with comfort and du- 
ration of life. Therefore, the first care in the prepa- 
ration of the abodes of man, and, it might be added, 
of domestic animals, should be the drainage of the 
soil. Eemoval of water from beneath and around the 
house and outbuildings increases warmth, fertility, 
and wholesomeness. What is true in this respect of 
an isolated habitation, is also true of collections of 
habitations in the village and groups of villages con- 
stituting the city. The only known means of pre- 
venting malarial diseases is good drainage. Surface 
drainage does much in this way. Drainage of the soil 
to the depth of two or three feet, as in the agricultu- 



26 MAXIMS OF PUBLIC HEALTH. 

ral regions .of England, does more. Entirely effective 
drainage of land should be to the depth of four or 
five feet. Drainage of the site of a habitation should 
be lower than the cellar and the foundation. 



XVII. 

The backhouse is not a relic of barbarism. Where- 
ever found, there is barbarism. Moses and the cat 
have taught mankind better than to construct and 
maintain such a Hindoo temple of filth. The great 
hole in the ground, near the habitation, to be grad- 
ually filled with the vilest human excrement, which 
undergoes constant putrefaction evolving poisonous 
gases, infecting and gradually supersaturating the 
surrounding earth, perhaps seeping into the water of 
an adjacent well, becoming the nidus of swiftly multi- 
plying germs of infectious diseases that nature labors 
to eliminate by the secreting functions of intestines, 
kidneys, or skin, is an abomination tolerated by ignor- 
ance, apathy, and vile habit. Clean it out, remove 
the dangerous contents far off to the hungry land, 
disinfect the desecrated place, fill it with clean earth, 
and sin no more. You can make a wholesome vault 
for seventy-five cents, if you are not too lazy, stupid, 
and obstinate. Buy an empty kerosene-barrel at the 
nearest grocery. Saw it in two, in the middle, and 
thus make of it two tubs which will not leak. Place 
the two on top of the ground under the holes in the 
privy-seat. Keep the contents of the tubs dry with 
the house ashes or with dry earth gathered in the 



MAXIMS OF PUBLIC HEALTH. 27 

summer. The contents of the tubs will evolve no 
gas, will not undergo putrefaction, will not smell to 
heaven or the other place, will not maintain the life 
of bacteria or disease germs, as long as such contents 
are kept perfectly dry by the admixture of ashes or 
desiccated earth. When the tubs are full, pull them 
out and spade the contents into the garden. In the 
mysterious alembic of nature the filth will be trans- 
formed into grass, fruit, or flowers, causing no nui- 
sance. If you have no garden, send the tubs away to 
be emptied on the land. This will cost much less 
than the cleaning of a devil's magazine of pestilence 
called a privy- vault. The simplest and cheapest form 
of the earth-closet is here commended. 



XVIII. 

Investigators must not forget the fact that micro- 
scopic plants and animals become the causes of dis- 
eases in man only when they are parasitic. Neither 
must investigators forget the further fact that micro- 
scopic animals, like other animals, breed by fecun- 
dated ova ; and that microscopic plants, like other 
plants, are propagated by fertilized seeds. Bisection, 
budding, transplanting, growth from layers, etc., are 
subordinate to the main facts, yet important. It is 
not sufficient, for example, to study the Bacillus an- 
tliracis as a plant which gives a milder form of 
splenic fever, which is easily destroyed by the heat of 
boiling water ; but the spores must also be studied, 
which give the deadly form of the same fever, which, 



28 MAXIMS OF PUBLIC HEALTH. 

as Professor Tyndall has demonstrated, can be de- 
stroyed only by about 340° of heat. The subject opens 
up a wide field for hypothesis and experiment. It is 
well known that a "black" frost entirely arrests yel- 
low fever. A " black " frost may kill the yellow-fever 
plant and arrest the germination of its spores. Yet 
the same spores may germinate with the returning 
warmth of the following season and continue the dis- 
ease. A frost will kill the young corn-plant. Yet 
seed-corn may be hung up in an atmosphere below 
zero all winter without losing its vital power to 
sprout — under proper conditions of soil, moisture, and 
warmth — the following summer. Wheat has grown 
well after remaining several thousand years in an 
Egyptian tomb. Heat is more likely to destroy germs 
than cold. Boil seed-corn, and it will not grow. It 
is a known fact that steam will disinfect a ship of 
yellow-fever. It is a known fact that freezing will 
not. Yet sanitary "cranks" persist in advising the 
destruction of yellow-fever germs in ships by cold. 
I predict that in due time superheated steam will be 
used to destroy germs of cholera, typhoid, typhus, 
and other zymotic diseases, not only in ships, but in 
other places where it can be made available. 



At a meeting of the French Horticultural Society, 
says Colonel Waring, there was a discussion as to the 
influence of plants on water containing putrefying 
organic matter ; and evidence was adduced to show 



MAXIMS OF PUBLIC HEALTH. 29 

that, while such water, left to itself, retains its putres- 
cent character, the same water in which roots of 
growing plants are feeding loses entirely the bacteria 
which accompany putrescence and contains only the 
larger infusorias which are peculiar to wholesome 
water. It was sufficient to allow a living root to act 
for five days, for the water to lose all its bad smell and 
to become purified. It is a sound instinct of humanity 
that leads to the planting of trees around a spring or 
well. An elm or soft maple, planted over a buried 
vault, will in time do scavenger- work that ought to 
have been done more promptly at the outset. A bed 
of sunflower-plants will rapidly appropriate foul mois- 
ture in a neglected or abused corner of the yard or 
garden. The eucalyptus, above all other trees, drinks 
up a vast quantity of malarial water. A judicious 
planting of the thirsty eucalyptus has made wide re- 
gions of Italy and Algeria healthy. I cut the following 
from a newspaper : " "Where there is surplus moisture 
to dispose of, as, for example, a cesspool to keep dry, 
a large eucalyptus will accomplish not a little, and a 
group of them will dispose of house-sewage. But if 
you have water which you do not wish to exhaust, as 
in a good well, it would be wise to put the eucalyptus 
very far away. Daniel Sweet, of Bay Island Farm, 
Alameda County, Cal., recently found a curious root- 
formation of eucalyptus in the bottom of his well, about 
sixteen feet below the surface. The tree to which 
the roots belonged stood fifty feet from the well. Two 
shoots pierced through the brick wall of the well, and, 
sending off millions of fibers, formed a dense mat that 



30 MAXIMS OF PUBLIC HEALTH. 

completely covered the bottom of the well. Most of 
these fibers were no larger than threads, and were so 
woven and intertwisted as to form a mat as impene- 
trable and strong as though regularly woven in a loom. 
The mat, when first taken out of the well, was water- 
soaked and covered with mud, and nearly all a man 
could lift, but, when dry, it was nearly as soft to the 
touch as wool, and weighed only a few ounces. This 
is a good illustration of how the eucalyptus absorbs 
moisture, its roots going so far to find water, pushing 
themselves through a brick wall, and then developing 
enormously after the water is reached. Mr. Sweet 
thinks one of the causes of the drying up of wells is 
the insatiable thirst of these vegetable monsters." 
The eucalyptus flourishes well in our Southern States 
and in California, Plant-life of all kinds feeds on 
the dangerous decay of animal life. Flower-beds 
around habitations are wholesome as well as pleasant 
to the eye. 



Quarantine, in the earlier sense of the term, is a 
relic of ignorance and of its consequent barbarism. 
To shut well people up a certain number of days in 
an infected ship is cruel, and may be murderous. Ee- 
move the sick at once to a proper hospital on shore. 
Let them remain there till cured. Eemove those who 
have been exposed to an infectious disease to a proper 
place of detention on shore, there to remain till all 
danger of "coming down" with the disease is over. 
Then let them go. If any " come down " there, trans- 



MAXIMS OF PUBLIC HEALTH. 31 

fer them to the hospital among the sick. The nat- 
ural history of infectious diseases is now so well 
known that a properly qualified officer can manage 
the matter with entire safety to the public and with 
humanity to the suffering and the exposed. Let the 
ship and its cargo, as well as all personal effects, be 
thoroughly disinfected, without unnecessary delay. 
With knowledge and care such disinfecting can be 
made entirely safe. After which- let the ship go 
about its business. Quarantine, in its new and 
proper sense, is now an exact science. Its agents 
must be chosen with sole reference to their capacity 
and honesty. With proper experts, quarantine may 
be made a successful art, to the great relief of com- 
merce, while the public is protected. 



How harmless, non-parasitic growths may be trans- 
formed into poisonous and parasitic ones, has been 
hypothetical^ described, with both ingenuity and 
learning, by Dr. Roberts, of Manchester, England, 
in an address delivered to the British Medical Asso- 
ciation, of which he was then president. "If con- 
tagia are organisms," he says, "they must possess the 
fundamental tendencies and attributes of all organ- 
ized things. Among the most important of these at- 
tributes is the capacity for ' variation ' or ' sport- 
ing.' This capacity is an essential link in the theory 
of evolution, and Darwin brings forth strong grounds 
for the belief that variation in plants and animals is 



32 MAXIMS OF PUBLIC HEALTH. 

not the result of chance or caprice, but is the definite 
effect of definite (though often quite obscure) causes. 
I see no more difficulty in believing that the Bacillus 
anthracis is a sport from the Bacillus suMilis* than in 
believing, as all botanists tell us, that the bitter almond 
is a sport from the sweet almond — the one a bland, in- 
nocuous fruit, and the other containing the elements 
of a deadly poison. Cholera suddenly breaks out in 
some remote districts in India, and spreads from that 
center over half the globe. In three or four seasons 
the epidemic dies away and ceases altogether from 
among men. A few years later it reappears and 
spreads again, and disappears as before. Does not 
this look as if the cholera virus were an occasional 
sport from some Indian saprophyte, which, by varia- 
tion, has acquired a parasitic habit, and, having run 
through countless generations, either dies out or re- 
verts again to its original type ? Similarly, typhoid 
fever might be explained as a variation from some 
common saprophyte of our stagnant pools or sewers, 
which, under certain conditions of its own surround- 
ings, or certain conditions within the human body, 
acquires a parasitic habit. Having acquired this 
habit, it becomes a contagious virus, which is trans- 
mitted with its new habit through a certain number 
of generations ; but, finally, these conditions ceasing, 
it reverts again to its original non-parasitic type." 

* The allusion is to a conclusion of Professor Cohn, that the 
deadly Bacillus anthracis is identical, in development and form, with 
the harmless Bacillus subtilis — only the rods of the latter move, while 
the rods of the former are motionless. 



MAXIMS OF PUBLIC HEALTH. 33 

This brilliant hypothesis explains not only the origin 
of epidemic diseases, but also their de novo appearance, 
without continuity of contagion. At the same time 
it avoids the irrational doctrine of heterogeneous ori- 
gin of species. 



The daily cost of milk in a city of one hundred 
thousand inhabitants is not less than one thousand 
dollars. The total cost for a year is $365,000. If 
the food-value of milk is diminished only ten per 
cent — a very low estimate — the annual loss to the 
consumers would be $36,500. A tenth part of this 
sum would provide for thorough inspection under 
a proper law. "Will somebody tell us why proper 
legislation on the subject is so difficult ? The pe- 
cuniary loss is the least of the resulting evils. 



Medical and sanitary journals are filled with dis- 
tressing accounts of the spread of typhoid fever, scar- 
latina, diphtheria, and other contagious diseases, by 
means of infected milk. Until stringent provisions 
can be made by law for the inspection of "dairies," 
including the families of dairymen and all who handle 
milk, the only safety for the people is to boil their 
milk before using it. The germs of disease are, as a 
rule, quite harmless when well cooked. 



34 MAXIMS OF PUBLIC HEALTH. 



In the city of Milwaukee I spent a month, as 
Commissioner of Health, in making a careful and 
faithful inspection of the " dairies " from which the 
milk-supply came. The conditions of food of cows, 
cleanliness and ventilation of stables, drainage, water, 
surroundings, etc. ; whether the animals were healthy, 
turned out to pasture in summer, constantly confined 
in winter, etc.; whether the proprietors were filthy, 
negligent, etc. — all the facts were written out separately 
for each " dairy," tabulated, and indexed. The index 
alone made oyer two hundred and fifty pages of manu- 
script. When all was completed, I invited citizens, 
through every newspaper in town, to call at the health- 
office and read a detailed description of the places 
from which they obtained milk for their households. 
Out of 120,000 inhabitants, the population at that 
time, just eleven came to see the record. Yet the 
apathy of Milwaukee citizens on this subject is not ex- 
ceptional. Will somebody account for it in a rational 
way ? About fifty per cent of a city's mortality is 
of children under five years of age. Among the 
causes of such premature mortality, bad milk, or milk 
poisoned with disease-germs, may be reckoned among 
the first. The poor little ones, with their pale, up- 
turned faces, with bloodless hands folded on their 
motionless breasts, with their dumb lips, plead to 
heaven in vain ; for even a voice from the dead can 
not arouse the living from a fatalism more appalling 
than that of the Mohammedans. What effect would it 



MAXIMS OF PUBLIC HEALTH. 35 

have if an enlightened preacher, instead of talking at 
the funeral about a mysterious Providence, were to 
accuse the milkman point-blank of murder ? The 
people would probably mob the preacher instead of 
the milkman. 



"No animal," says Professor "Van Beneden, of 
Louvain, " at any time has attracted so much atten- 
tion as that little worm which lives in flesh, rolled up ; 
it is about the size of a millet-seed, and was found by 
chance in the dissecting-room of a London hospital, 
some forty years ago. * . . * The trichina is a nema- 
toid worm, and not an insect, as it was at first called. 
Let us imagine an extremely slender pin, . . . rolled 
upon itself in a spiral form, so as to lodge in a cavity 
hollowed out in the midst of the muscles, in a space 
not larger than a grain of millet. . . . Professor E. 
Owen . . . gave them the name trichina, because 
they are thin as a hair ; he added the specific name 
of spiralis on account of the manner in which they 
were rolled up in their cyst. Trichina spiralis is 
therefore the name of this animal. 

" The trichinge, which are now completely known 
in the minutest details of organization and manner of 
life, have a distinct mouth, and they have a complete 
digestive tube, with an orifice at each end of the body, 
like all worms in the form of a thread, which, for 
this reason, are called by naturalists nematoids, as 

* It was in 1832. 



36 MAXIMS OF PUBLIC HEALTH. 

opposed to cestoids (in the form of a ribbon or tape). 
Besides this nutritive apparatus, trichinae, like nema- 
toids in general, have the sexes divided into two dis- 
tinct individuals, so that there are males and females, 
which can be easily distinguished from each other by 
the form and size of the body. 

" Trichinae are found in the flesh of almost all the 
mammals. If we eat this trichinous flesh, the worms 
become free in the stomach as digestion goes on, and 
they are developed with extreme rapidity." 

With this general description by Professor Yan 
Beneden in mind, let us follow the migration of the 
little viper from the flesh of a pig into the flesh of 
a man. A piece of raw or half-cooked pork, contain- 
ing encysted trichinae, is eaten. In the stomach the 
cysts are digested enough to set the worms free. It 
would take twenty-eight of them, placed end to end, to 
measure an inch in length. It would take six hun- 
dred of them, laid side by side, to measure an inch 
in width. After being set free, they pass from the 
stomach into the intestines, and uncoil themselves. 
Then they grow very rapidly, and develop their sexual 
character. When grown, it would take only from 
seven to nine of them, placed end to end, to measure 
an inch. A great number of eggs in the females are 
developed into embryos. Birth is given to a myriad 
of little trichinae, so small that it would take from 
one hundred and twenty to one hundred and forty of 
them, placed end to end, to measure an inch. The 
enterprising little rascals bore their way through the 
intestines, and travel to every part of the body. The 



MAXIMS OF PUBLIC HEALTH. 37 

tissues are irritated by the journeying of the animals, 
which tunnel as they go. Besides, they grow rapidly. 
And when they have selected and pre-empted a " home- 
stead," they coil themselves up, and about each one 
separately is built a house or cyst. They have now 
reached the same size the parents had when they first 
entered the human stomach. Here they wait — years, it 
may be — for some other animal to devour the flesh in 
which they are buried, when they, too, may be set free 
and enjoy a brief honeymoon, like their progenitors. 

The disease caused by the migration of the little 
trichina? from the intestines to the muscular parts of 
the body, and by their growth, is dreadful, and very 
often fatal. It resembles typhoid fever, with swell- 
ing and intense pain of the muscles. Death usually 
takes place in the fourth week. The worms have 
then done traveling, are developed and encysted. If 
the patients survive that period, they may live on 
for years, but they are pretty densely populated with 
worms. In a pound of human flesh, Leuckart found 
700,000 trichinae. In a cubic inch, 80,000 have been 
counted. It has been estimated that as many as 250,- 
000,000 may exist in a single pig. 

Trichina? are very tenacious of life. Death of the 
animal which they inhabit does not destroy them. 
Complete decomposition of meat filled with them 
does not extinguish the vital spark of their existence. 
Freezing does them no harm. According to Kiichen- 
meister, ordinary smoking of meat does not disturb 
trichina?. The corpse of a pig infected with them 
may be entombed in a pork-barrel, with plenty of 



38 MAXIMS OF PUBLIC HEALTH. 

salt, and the worms will survive. The carcass of an 
animal peopled with trichinae may be "imprisoned 
in thick-ribbed ice," may "lie in cold obstruction, 
and rot," without disturbing its encysted denizens. 
There is something sublime, even poetic, in the long, 
dumb expectancy of these little creatures, in their 
solitary and silent hope of a resurrection in the blood- 
warm stomach of some unknown animal, there to 
realize the Mohammedan glories of a new and fruit- 
ful life. 

The only convenient thing that will kill them is 
an orthodox dose of fire. Man usually receives trichinae 
from pork. According to Fiedler, a temperature of 
155° Fahr. will destroy free trichinae ; but the encap- 
suled trichinae require greater heat. I should advise 
giving them a wholesome Calvinistic climate of about 
300°. Nothing but the thorough cooking of pork 
can make it safe food for man. If it cuts red and 
rare, like beef, on the table, it should be avoided 
with religious determination. 

There have been grave epidemics of trichinosis in 
Germany and the United States. The disease has 
probably been more frequent than hitherto observed. 
Swine fed on garbage, dead rats, and offal are much 
more likely to be infected than those fed on the 
wholesome products of farms. 



I cut the following from the Detroit "Medical 
Age," whose bright editor states the fact very clear- 



MAXIMS OF PUBLIC HEALTH. 39 

ly : " The Ill-doings of Flies.— Dr. B. Grassi, of Rovel- 
lasca, reports, in a recent number of the 'Gazetta 
degli Ospitali,' some investigations he has been mak- 
ing on the above subject. He has convinced himself 
that the common house-fly is a dreadful enemy of 
the human race, as of all living things in general. 
Whenever any infectious product is present — for in- 
stance, the sputa of phthisical patients, or dejecta 
from the intestinal tract — swarms of flies are to be 
seen, which soil themselves with the offensive ma- 
terial, and then crawl about over our food. The writer 
placed a plate containing a large mass of the ova of 
a human parasite (trichocephalus) upon a table in 
his laboratory, which was situated at the distance of 
about thirty feet from the kitchen. Sheets of white 
paper were placed in various parts of the kitchen, and 
in the course of a few hours the dejecta of flies were 
observable on the paper. Upon examination of these 
with a microscope, they were found to contain some 
of the ova of the parasite. Dr. Grassi then killed 
some of the flies, and found an enormous mass of 
fseces containing more of the ova. On another oc- 
casion he minced some segments of tape-worm that 
had been preserved in spirit, and put them into water, 
so that a mass of ova were suspended in it. In half 
an hour he succeeded in finding the ova of the para- 
site in the abdominal contents of the flies, and also in 
the spontaneously deposited dejecta. In like manner . 
it could be proved that flies, that had alighted on 
moldy cream, harbored the spores of oidium lactis. 
It is useless to comfort one's self with the thought 



40 MAXIMS OF PUBLIC HEALTH. 

that these germs die in the intestines of the flies. 
Even if the intestinal juice do act upon them, and it 
is not proved that it does in the case of bacteria, some 
would almost certainly escape destruction. In any 
case, moreover, the legs and proboscis would still 
serve as carriers of the infection. He proposes that 
attempts shall be made to introduce the same disease 
among them in the spring-time that already causes 
such devastation in the autumn," 

It is very important to cover all articles of food 
with fine wire netting in " fly- time." During the hot 
season, when particles of organic matter are under- 
going rapid putrefaction, flies do a great deal of use- 
ful scavenger- work ; but they are not needed in a 
clean house. Shut them out with window-screens, 
for the sake of sanitary safety as well as comfort. 



Free love, as between you and your neighbor's 
wife, may be very agreeable to you ; but, as between 
your neighbor and your wife, is sure to be disagree- 
able to you. So, a cesspool on the back end of your 
lot, under your neighbor's dining-room window, may 
be convenient for you ; but a cesspool on the back 
end of your neighbor's lot, under your dining-room 
window, is not entirely satisfactory to you. 



One gallon of water, let through a soil-pipe with a 
rush, in a mass, as it were in a small flood, will flush 



MAXIMS OF PUBLIC HEALTH. 41 

better and cleanse more than a whole barrel of water 
flowing in a small, continuous stream. Look for this 
quality always in selecting a water-closet. The pan- 
closet should never be used. It is nearly as disagree- 
able and quite as dangerous as a chamber-vessel con- 
stantly standing half-full in the same space. 



The best way to avoid sewer-gas is to make none. 
Nature gets rid of organic matter by letting loose in 
it myriads of bacteria, or by setting up in it a growth 
of countless invisible plants, which transform it and 
utilize it without loss. Nature, while seemingly prodi- 
gal, is infinitesimally economic. During this process 
of transformation, gas is evolved which is deleterious 
to human life. This is exactly sewer-gas, whether 
the gas is made in a sewer, house-drain, vault, cess- 
pool, or other place ! * Whether the poison is a septic 
element in the gas or a living thing is not a settled 
question. Most scientists regard the poison as consist- 

* A distinction is frequently made between sewer-gas and malaria. 
The gas produced by the decomposition of vegetable matter, may be 
called malaria ; that produced by the decomposition of animal mat- 
ter may be called sewer-gas. When the matter is mixed, vegetable 
and animal, the gaseous product of its decomposition is mixed. As 
the vegetable and animal kingdoms have an indefinite boundary, it 
would be difficult to keep up a distinction in a practical discussion. 
As people may sicken or die through the instrumentality of malaria 
as well as of sewer-gas, the same pains should be taken and the 
same means employed to dispose of organic matter of vegetable as 
of animal origin. 



42 MAXIMS OF PUBLIC HEALTH. 

ing of microscopic plants or animals, or their minute 
ova and spores, floating in the gas, conveyed by water, 
food, or air, to the human body, there to germinate, 
grow, multiply, causing, under favoring conditions, dis- 
eases. Some of these germs, once created in the labora- 
tory of Nature, continue their existence according to 
the laws governing the origin and development of spe- 
cies. When these germs, so-called, become the causes of 
disease, they constantly recur to their source. In other 
words, they have their natural habitat according to 
their origin. For example, the fungus of typhoid, or 
the bacillus of cholera, may have had its origin in the 
putrefactive decomposition of the excreta of the sickly 
intestinal tract, as a poisonous "variation" of an in- 
nocent fungus, or bacillus, and finds, by "shadowy 
recollections," by life-instinct, its home, its habitat, 
its primal source, in the same tract, through drink- 
ing-water or food, multiplying the disease from genera- 
tion to generation. The germ of typhus or scarlatina 
may have had its origin in the putrefaction of the ex- 
halation of the lungs or skin, and may continue its 
life in a similar way. Hypothesis and conjecture, 
however, are useless, and I hasten to return to the 
realm of the practical. 

Nature attacks dead organic matter wherever she 
finds it. If it is thrown out at the back door, in 
kitchen-slops, she attacks it there, and there generates 
from it a more or less dangerous poison. If it is de- 
posited in a vault, cesspool, or sewer, Nature takes it 
where she finds it. Nature makes no haste and takes 
no rest. Some hours intervene before putrefaction 



MAXIMS OF PUBLIC HEALTH. 43 

gets under way. It lasts as long as there is any un- 
eonsumed matter left, " growing by what it feeds on." 
If new matter is perpetually added, putrefaction never 
ends. The amount of matter furnished by our habita- 
tions, stables, and factories is enormous. One thousand 
persons, as the population averages, produce over one 
ton of excreta, from intestines and kidneys, every 
twenty-four hours. For a city of one hundred thou- 
sand inhabitants, the daily amount is over one hun- 
dred tons. About forty thousand tons annually ! 
That does not include the putrescible excretion of 
the skin, which defiles a vast amount of wash-water. 
Kitchen-slops and garbage constitute an important 
factor. Add, also, the excreta of animals, in stables, 
cow-barns, hog-pens, henneries, kennels, etc. The re- 
fuse of slaughter-houses and various manufacturing 
places must not be overlooked. The organic refuse 
of inhabited places is about one ton per capita per 
annum. 

What should be done with all this perilous putres- 
cible stuff ? It would take much space to tell what 
is done with it, in isolated country houses, in villages, 
in cities. It is easier and better to teach what ought 
to be done with it than to denounce existing methods. 

All solid organic refuse should be carted away 
from inhabited places before putrefactive decompo- 
sition begins. Garbage, manure, offal, street "clean- 
ings," etc., can not safely be disposed of in any other 
way. What utilization should be made of such ma- 
terial is an economic question that need not be dis- 
cussed here. Only it must not be forgotten that the 



44 MAXIMS OF PUBLIC HEALTH. 

sanitary question is paramount, as health and life are 
more important, even from a money point of view, 
than the value of fertilizers. 

Liquid waste, water carrying in solution or sus- 
pension putrescible organic matter, is most easily dis- 
posed of by means of a sewerage system. The sew- 
age of a house, village, or city is exactly the water 
used and fouled with the refuse, of life. This sew- 
age should be kept separate, and constantly removed 
by pipes exclusively used for that purpose. No rain- 
water or ground- water should be mixed with it. 
The sewerage system should be constructed of the 
best vitrified or glass pipes, and of no other material. 
A brick sewer will inevitably absorb sewage, and pro- 
duce sewer-gas. Each brick will absorb about one 
pound of this liquid, which becomes diabolical as soon 
as it has time to begin putrefactive decomposition. 
As the quantity of the sewage is measured by the 
quantity of the water-supply, the pipes in the sewer 
system need not be large, not very much larger than 
the water-pipes. And they may be so distributed to 
the outfall that large mains will nowhere be needed. 
These vitrified or glass pipes should be laid with the 
greatest engineering care, so as to secure tight joints 
and a constant flow. All " dead ends " should be well 
washed out at least twice daily by means of automatic 
flush-tanks. Opposite to every lot an acute-angled 
connection should be made, from which a branch of 
the same material should be run to a point near, but 
not under, the wall of the building from which sew- 
age is to be conveyed. At that point tight connection 



MAXIMS OF PUBLIC HEALTH. 45 

should be made with the cast-iron soil-pipe of the 
building, which soil-pipe should be run up through 
the building, full caliber, and open at the top above 
the roof. The joints of the iron soil-pipe should be 
calked, gas and water tight, with lead. The pipe it- 
self, before use, should be tested for defects. From 
the open top, above the roof, all the way to the sewer- 
pipe in the street, there should be no trap. The 
whole system will then be ventilated high up in the 
air over the whole town. Into the soil-pipe openings 
must be made for the waste-pipes from the kitchen- 
sink, stationary wash-basins, bath-tubs, and water- 
closets. These waste-pipes must be trapped in the 
best manner, and the traps must be ventilated to 
prevent siphoning. Eoof-water, surface-water, water 
from the under-drainage of the site of the building, 
water from the overflow of cisterns, and water from 
the melting of ice in refrigerators, must not be con- 
ducted into the soil-pipe, or into the sewer system. 
A separate drainage system must be constructed for 
the removal of all storm-water and other water un- 
contaminated with organic matter. 

The outfall of the sewerage system should re- 
ceive especial attention. The sewage of a city will 
contaminate a large body of water if emptied into it. 
A great and rapidly flowing river may safely receive 
the sewage of a town, but in most places it must be 
removed, by pumping or otherwise, to a sufficient 
tract of prepared land, to be disposed of by irrigation 
or intermittent downward filtration. Sewage thus 
kept by itself is manageable, because constant in 



46 MAXIMS OF PUBLIC HEALTH. 

quantity, and may perhaps be made profitable for 
fertilization. When mixed with ever-varying and 
sometimes vast quantities of storm-water, it is diffi- 
cult, costly, and never profitable, to dispose of it in 
that way. 

If the plan here described is followed, no sewer- 
gas will be created, within the area of inhabited 
places. No sanitary measure is of equal value in con- 
serving the productive energy of the people. 

XXX. 

The prevalent practice of removing sewage by 
means of the water-drainage system of inhabited 
places is open to many and very serious objections : 

Ditches, gutters, tiles, and porous brick conduits 
for removing surface and subsoil water are compara- 
tively cheap. It adds immensely to the cost to trans- 
form water-drains into sewers, so as to make them at 
all fit to convey liquid wastes. The combined expense 
of a separate drainage system and an independent 
sewer system is less than the expense of a single 
system that can not be so constructed as to perform 
well the double service of removing water from the 
soil and liquid refuse from habitations. 

In most places it is not difficult to find a proper 
outfall for the water of a drainage system. As soon 
as sewage is mixed with the flow of drains, the whole 
mass is contaminated, and the trouble and cost of se- 
curing a safe outfall are, as a rule, greatly increased. 
The necessity of pumping vast quantities of rain- 



MAXIMS OF PUBLIC HEALTH. 47 

water and subsoil-water, mingled with the liquid 
refuse of houses and factories in the same system in 
the new sewerage-works of Berlin and Dantzic, in- 
creases the running expenses to an extent threaten- 
ing failure. 

The sewage proper of a city is nearly a constant 
quantity. It is measured by the amount of water daily 
used in houses and factories. Consequently, the en- 
gineer, in constructing a system for the removal of 
sewage proper, can adapt it to a constant flow, and 
make it self-cleansing. On the contrary, rainfall is 
an immensely variable quantity. A drainage system 
for its removal must be of maximum size. When sew- 
age, therefore, is turned into the drainage system, a 
slow flow will be inevitable much of the time, result- 
ing in putrefaction and the generation of sewer-gas, 
the presence of which within the area of inhabited 
places dangerously violates the most vital law of sani- 
tation. 

In the drainage system all conduits are purposely 
made to let water in. The object is to convey water 
away from the soil. But a porous drain will strain 
sewage through into the earth, and gradually pol- 
lute it. Consequently, a conduit for the conveyance 
of sewage must be tight — hence the absolute incom- 
patibility of the two ends sought in the same struct- 
ure. A good sewer is a bad drain. A good drain is 
a dangerous sewer. Attempts are constantly renewed 
to attain the double quality of perviousness from with- 
out and imperviousness from within, with unceasing 
and inevitable failure. Sanitarians who are quacks 



48 MAXIMS OF PUBLIC HEALTH. 

in engineering have tried it in vain. Engineers who 
are quacks in sanitation have tried it equally in vain. 
Quacks in both engineering and sanitation, well rep- 
resented in city boards of public works, obstinately 
keep up their search for the unattainable, like the 
seekers of the philosopher's stone and the inventors 
of perpetual motion. 

Water stored in cisterns is almost invariably poi- 
soned by the way of overflow-pipes which discharge 
into the sewer systems of inhabited places and return 
the dangerous gas. And the drain-pipes from cel- 
lars and basements generally furnish avenues through 
which this invisible foe of human life in cities finds 
easy ingress to habitations. A separate drainage sys- 
tem affords an easy means of guarding against peril 
from such a source. Sanitary inspectors are often as- 
tounded by finding a tube from an ice-box, in which 
choice and delicate food, like meats and milk, is kept, 
running directly into a sewer-pipe. The combined 
sanitary and engineering quack will tell you, with 
pitiful ignorance, that the deadly sewer-gas is kept 
out by means of a little water-trap through which a 
baby could blow with a straw. A separate system, 
used exclusively for sewage, is the only certain safety 
against such danger. 

With the clumsy, costly, perilous, combined sys- 
tem in general use for removing water and sewage 
together, the earth of towns gradually becomes in- 
fected with organic matter in a state of putrescence. 
Hence the water of springs and wells at length be- 
comes polluted and unfit for use. With a separate, 



MAXIMS OF PUBLIC HEALTH. 49 

properly constructed and properly managed system of 
impervious pipes for the removal of all sewage, and 
with other sound sanitary regulations for the care and 
removal of solid organic refuse, there is no reason 
why the spring- water and well-water of towns should 
not remain clean and wholesome. Besides, when the 
earth of inhabited places is kept so clean as to pre- 
serve the purity of the water, no exhalations will arise 
from it deleterious to health and dangerous to life. 



It has been objected, in relation to separate sys- 
tems for drainage and the removal of sewage, that 
droppings of horses and other animals in the streets, 
steeping in the rainfall, will be a source of pollution 
to surface-water, rendering it putrescible, and conse- 
quently capable of generating sewer-gas. The simple 
and effective remedy is cleaning the streets frequently 
and well. Most cities would thereby be greatly im- 
proved, both in appearance and salubrity. 

It has also been objected that, in quarters where 
the vitrified pipe-sewer system for the removal of sew- 
age does not extend, there the inhabitants must throw 
the liquid wastes of household life upon the ground. 
No such necessity exists. Even an isolated habitation 
in the country should have its sewer-pipes, entirely 
separate from the drainage system, to convey kitchen 
slops, wash-water, and other dangerous liquids to a 
place of safety. The reason why typhoid fever, diph- 
theria, and some other filth-diseases are so prevalent 



50 MAXIMS OF PUBLIC HEALTH. 

in country districts is, that privy-vaults so frequently 
seep into wells, and the animal excreta of pig-pens and 
stables are left to poison the earth and the air. The 
ground about kitchens, supersaturated with slops, 
very often becomes putrescent in the summer warmth, 
breeding disease which superstitious ignorance attrib- 
utes to Heaven. A householder may dispense with 
his parlor and its adornments, if necessary, but he 
can not afford to invite upon himself and family dis- 
ease and death by neglecting to provide the means 
of keeping the site of his habitation dry and clean. 
Laborare est orare — "To labor is to pray" — said the 
wise old monk, and the most effective prayer for 
health is to supply every needed hygienic device for 
the sacred home of the family. 

It is further objected that most of our cities are 
already sewered for the double purpose of removing 
storm-water and sewage through the same conduits, 
and that we can not afford to do the costly work over 
again. It is one of the fates of progress that faulty 
methods must be followed by reconstruction. JSTo 
works last forever ; and when we build anew we can 
do it better. In the mean time, the faulty old sewers 
with their dangerous debouchements into the nearest 
streams, lakes, or ocean-harbors, can be washed out, 
disinfected, and used exclusively for water- drain age, 
while a supplementary system, with safe outfall, for 
the removal of sewage alone, is constructed with proper 
engineering skill under the direction of sanitary sci- 
ence. The cost of such a supplementary system is not 
more than one fourth of that of the prevailing system. 



MAXIMS OF PUBLIC HEALTH. 51 



A great principle to be kept in view is the removal 
of sewage (not sewage diluted with vast quantities of 
surface and subsoil water) without pollution of the 
soil, without putrefaction, and consequently without 
generation of sewer-gas on the journey. 

The entire excreta of human beings may be admit- 
ted to the sewerage system for water-carriage. The 
privy-vault should not be tolerated in any civilized 
neighborhood. Where there is no sewer system, some 
form of earth-closet ought to be used, and the con- 
tents frequently removed. The liquid portion of the 
excreta of horses and other domestic animals should 
be constantly removed by the sewer system. The 
solid portion should not be thrown upon the ground 
and bleached by rain, but be kept under cover, dry, 
and be frequently carted away. In fact, no organic 
matter should be thrown on the ground, nor depos- 
ited in the ground near human habitations. The soil 
where man dwells is sacred, and it is sanitary sacrilege 
to pollute it. He who fouls the air that he breathes 
himself, or the water that he drinks, or the food that 
he eats, is a barbarian who might learn wisdom from 
the cat or decency from the swine. He who fouls the 
air that another must breathe, or the food that another 
must eat, or the water that another must drink, is a 
criminal to be classed with those who maim and kill. 

There are more reasons for care in the removal of 
organic wastes from inhabited places than appear on 
the surface. The chemistry and hygiene of putrefac- 



52 MAXIMS OF PUBLIC HEALTH. 

tion are complex, involving many practical considera- 
tions. Wherever there is a collection of putrefying 
organic matter, whether on the ground, in the ground, 
within a faulty sewer, or under a habitation, there is 
a tireless foe to health and life. Not only are putres- 
cent collections of garbage, decaying vegetables, ma- 
nure, offal, and human excreta harmful in themselves, 
by reason of exhalations poisoning the air and of leach- 
ing liquids polluting the earth ; they are also deposi- 
tories and multipliers of disease-germs. Such collec- 
tions may not produce infectious diseases de novo, but 
they lessen the vitality of people living in the neigh- 
borhood, and thereby lessen the power of resisting 
epidemics. It is a well-known pathological fact that 
Nature struggles to eliminate disease by excretory 
processes. Accumulations of filth containing excreta 
may therefore harbor seeds of various communicable 
maladies. Sewer-gas, while it may not beget scarla- 
tina, diphtheria, small-pox, and other contagious dis- 
eases, easily becomes the vehicle of conveying them, 
through obscure and intricate channels. Nor is this 
all. It is well known that a dung-heap will take 
cholera, hold it for an indefinite period, and convey 
it to human beings ; that is, cholera dejecta thrown 
upon a dung-heap will plant in it the germs of the 
disease, there to take root and multiply, and may 
communicate themselves to man under favoring cir- 
cumstances. A vault will take typhoid fever, have it 
badly for a long time, and communicate the disease 
to human beings. It is probable that a heap of pu- 
trescent garbage may catch diphtheria in the same 



MAXIMS OF PUBLIC HEALTH. 53 

way, multiply its germs, and communicate them to 
unsuspecting children. There is little doubt that 
every seething mass of organic matter is affected with 
yellow fever in the midst of an epidemic of that dis- 
ease. It is believed by many experienced physicians 
that yellow fever is not communicated from person 
to person, but is always caught from surrounding 



So great is the influence of filth in these various 
ways that no epidemic can make any serious headway 
in the midst of cleanliness. One frequented vault, 
down with typhoid fever, is more dangerous than a 
house full of patients. A big trunk, full of dirty 
clothes, sick with yellow fever, is more to be shunned 
than a small hospital full of human victims of the 
disease. A village dung-hill, planted with cholera, is 
more perilous than a dozen cholera-corpses. A foul 
sewer, swarming with scarlatina-germs, may be as 
dangerous to a neighborhood as an infected school- 
house. 



Whatever engineering device is employed for drain- 
ing the soil and removing rainfall should be used ex- 
clusively for the conveyance of water uncontaminated 
with putrescible organic matter. Such water may then 
be safely discharged into any convenient natural reser- 
voir, or adjacent stream, where economy and security 
from flood may dictate. For removing storm-water, 
surface-water, and subsoil- water from the isolated hab- 
itation, neatly constructed ditches, agricultural tiles 



54 MAXIMS OF PUBLIC HEALTH. 

properly laid, and occasionally deep drains of porous 
brick, will be sufficient. In villages, well-paved gut- 
ters, with more frequent and larger deep drains of 
porous brick, will be needed. In cities, brick mains, 
adapted in size to the areas from which the water is 
to be removed, must be added. A suitable size for the 
site of an isolated habitation, with its out-buildings, 
in the country, may be regarded as about three hun- 
dred feet square. The annual rainfall on that area, at 
the fair estimate of thirty-six inches, would amount 
to 270,000 cubic feet. The annual rainfall on a 
square mile, the average size of a village, would be 
nearly 84,000,000 cubic feet. On ten square miles, 
the area of a considerable city, the annual rainfall 
would be more than 836,000,000 cubic feet. On a 
city of ten square miles more than 20,000,000 cubic 
feet of water may be precipitated from the clouds in 
a single hour. These figures show that the drainage 
system of inhabited places should be adequate, as well 
as adapted to the desired end. Details belong, more 
especially, to the engineer, but he should know exactly 
what he is required to accomplish ; his art only fur- 
nishes the means to an end pointed out by sanitary 
science. 

xxxiv. 

Long before sanitary science had taken the form 
of public hygiene, Dr. Benjamin Eush, the sharpest 
medical observer and the profoundest medical thinker 
produced by America, came to the conclusion that the 
means of preventing pestilential fevers "are as much 



MAXIMS OF PUBLIC HEALTH. 55 

under the power of human reason and industry as 
preventing the evils of lightning and common fire. I 
am so satisfied of this opinion that I look for a time 
when oar courts of law shall punish cities and vil- 
lages for permitting any of the sources of bilious 
and malignant fevers to exist within their jurisdic- 
tion." 



Security from dampness and stagnant water is not 
only security from malarial fevers, but also, in a great 
measure, from consumption, scrofula, rheumatism, 
and various other diseases. Complete aeration of the 
soil, to the depth of five or six feet, by efficient un- 
der-drainage, enables the earth to oxidize, and thus 
disinfect a vast amount of polluting matter thrown 
upon it, increases its temperature, and removes from 
it the poisons that cause ague and bilious fever, that 
either produce or intensify scrofula, tuberculosis, ca- 
tarrh, bronchitis, and pneumonia ; that aid to spread 
and render more fatal small-pox, scarlatina, diph- 
theria, and other contagious diseases ; that gather to 
our cemeteries a more abundant annual harvest of the 
old, the young, and the feeble. "I feel assured," 
says Mr. Denton, "that as certainly as we of this 
generation are now engaged in removing from our 
rivers the polluting matters which the authorities of 
the last generation obliged our fathers to discharge 
into them, so will those who come after us lament 
with shame, and do their best to repair, the disregard 
paid by our present authorities to the drying of the 



56 MAXIMS OF PUBLIC HEALTH. 

sites of habitations as one of the first considerations 
for the preservation of human life." 



XXXVI. 

Municipal corporations, like individuals, are liable 
for damages caused by maintaining nuisances (Don- 
ahue vs. New York, 4 Daly, 65 ; Harper vs. Milwau- 
kee, 30 Wis., 365 ; Brower vs. Mayor of New York, 
3 Barb., 254 ; Dorman vs. Jacksonville, 13 Fla., 538). 
A municipal corporation is liable in damages for dis- 
charging its sewers on private property (O'Brien vs. 
St. Paul, 18 Minn., 176). A municipal corporation 
may prevent and remove a nuisance, but a city gov- 
ernment has no authority to sanction or license a 
nuisance (Adm'r of Chambers vs. Ohio Life and 
Trust Ins. Co., 1 Disney, 327 ; Eyan vs. Capes, 11 
Rich., S. C, 1217 ; Pfau vs. Reynolds, 53 111., 212 ; 
Columbus vs. Jacques, 30 Ga., 506 ; Com. vs. Rush, 
14 Pa. St., 186). Still less has an individual member 
of a municipal corporation authority to sanction a 
nuisance. Any individual, especially injured, has a 
right of action for damages against a municipal cor- 
poration for maintaining a public nuisance (Doo- 
little vs. Supervisors, 18 N. Y., 155 ; Thayer vs. Bos- 
ton, 19 Pick., 291 ; Hunt vs. Mayor of Albany, 9 
Wend., 751 ; St. John vs. the Mayor, 3 Bosw, N. Y., 
483 ; People vs. Albany, 11 Wend., 539). The law on 
this point is settled, and there is no need of quoting 
more authorities. 

Besides, a corporation is liable to criminal indict- 



MAXIM 8 OF PUBLIC HEALTH. 57 

ment if it does not make reasonable haste to abate a 
nuisance. " No reason appears," says Bishop (" Crim- 
inal Law," § 418), " why a corporation, having by law 
power to act, should not have also by law the power 
to intend to act ; and mere intentional wrong acting 
is all which is necessary in a class of criminal cases " 
(The State vs. Barksdale, 5 Humph., 154; The State 
vs. Mayor and Aldermen of Murfreesboro, 11 Humph., 
217 ; Rex vs. Hendon, 4 B. and Ad., 628). "When 
the law," again says Bishop, "casts upon any corpo- 
ration an obligation of such a nature that the neglect 
of it would be indictable in an individual, the cor- 
poration neglecting it may be indicted " (People vs. 
Albany, 11 Wend., 539; Lyme Regis vs. Henley, 3 
B. Ad., 77, 92, 93). It is a legal principle universally 
acknowledged that corporations are indictable for non- 
feasance. In cases where municipal corporations are 
not indictable for misfeasance, for the reason that they 
" have no souls," and are therefore incapable of crimi- 
nal intent, yet the individuals constituting their gov- 
ernment can not plead such inability, and are, there- 
fore, liable to criminal indictment. 

XXXVII. 

The doctrine of a contagium vivum has many able 
opponents, like Dr. B. W. Richardson. Others, like 
Dr. Burdon-Sanderson, take a middle ground, and 
maintain that living contagia are " molecular aggre- 
gates," ultra-microscopical, "of which all we can say 
is that they occupy the border-land between the liv- 



58 MAXIMS OF PUBLIC HEALTH. 

ing and the non-living things." Professor Tyndall 
responds that, " between the microscopic limits and 
the true molecular limits, there is room for infinite 
permutations and combinations," and that "a parti- 
cle, whether great or small, which, when sown, pro 
duces a plant, is proved thereby to be the germ of 
that plant. " The conflict is between the ground ker- 
nel of wheat and the whole kernel, between the broken 
egg and the egg entire. On the one hand, it is main- 
tained that different kinds of septic matter, acting as 
diffusive poisons or ferments, produce the various dis- 
eases that flesh is heir to. On the other hand, it is 
maintained that every disease has its origin in a vital 
germ that multiplies itself indefinitely in the fertile 
soil of the human body. The weight of scientific 
opinion is now in favor of the latter theory. But, 
practically, it makes no difference which theory is 
correct. Mankind are just as anxious to escape being 
poisoned by a living thing as by a dead thing. It is 
just as hard to see a friend die with splenic fever, the 
cause of which is demonstrably known, as with enteric 
fever, the cause of which is unknown. Fortunately, 
the sanitarian is not obliged to wait for a solution of 
the great and interesting problem ; he has to use the 
same means of preventing disease, whether disease is 
caused by living germs or dead ferments. 



The slaughtering of animals should never be toler- 
ated in large cities. The driving of animals through 



MAXIMS OF PUBLIC HEALTH. 59 

the streets is itself a nuisance. The pens, in the rear 
of butchers' shops, where cattle, pigs, sheep, and 
calves are kept till their proprietors are ready to kill 
them, are frequently noisy, and always more or less 
offensive to the sense of smell. Not unfrequently the 
slaughtering is done in view of upper windows from 
which it is witnessed by women and children. The 
cry of animals, destined to the shambles, is unpleasant 
to the ear and distressing to the imagination. It is 
difficult to remove, especially in summer, the blood 
and offal of slaughtered animals without leaving an 
odor that is at once offensive and deleterious. When 
the weather is hot, the refuse of butchering-places is 
sure to taint the air before the expiration of the pre- 
scribed twenty-four hours, within which the law gen- 
erally requires it to be removed. Sometimes it is hid- 
den in a shed or dark alley, till the stench of it drives 
the neighbors to the health-office for protection or re- 
dress. And the vile carrion must be drawn along the 
streets, either by night or in the day-time. Besides, 
the thrifty butcher tries out the scraps for tallow or 
grease, giving the unfortunate neighborhood the sick- 
ening benefit of rendering in open kettles. The spilled 
blood and filth are at best washed into the public sew- 
ers, adding to the organic matter that undergoes pu- 
trefactive decay and generates noxious gases. Some- 
times blood and liquid are allowed to run through 
defective floors or directly on to the ground, where they 
slowly accumulate and poison the earth. Now and 
then, if avarice, ignorance, and apathy are uncon- 
trolled, an adjoining hog-pen, with its unclean, offal- 



60 MAXIMS OF PUBLIC HEALTH. 

fed swine, increases the nuisance. When the proprie- 
tor does his best to keep his place in a neat and whole- 
some condition, the very nature of the business stamps 
it as an "offensive trade." 

A meat-market need not be more offensive or un- 
wholesome than a grocery. It is the slaughtering part 
of the place that creates a nuisance. The sight of 
good, clean butcher's meat is far from being repulsive. 
The slaughtering should be done outside of a city, and 
the sides of beef, carcasses of sheep, lambs, swine, 
calves, etc., should be brought by dealers to their 
markets, where the people can be served with exactly 
the same convenience as at present. 

Butchers would find it more economic to combine 
their interests, so far as slaughtering is concerned, 
and provide for themselves a place in common beyond 
the confines of a town. Co-operation and aggregated 
capital would secure conveniences which few individu- 
als can command. Modern appliances and improved 
machinery might then be secured. All the profits of 
extracting glue from the feet, of manufacturing fer- 
tilizers from blood and offal, of rendering grease from 
refuse parts, of utilizing hoofs and horns, of preparing 
tripe and souse, of making sausages for distant mar- 
kets, of curing bacon and drying beef away from the 
dust and gases of a crowded city, of salting hides, etc., 
might then accrue to the ownership of the great 
slaughtering-place, or abattoir. The cost of bringing 
the meat to the markets would be less than the cost 
of driving animals, by squads, to inclosures where, too 
often, they are barbarously slain by unskilled hands 



MAXIMS OF PUBLIC HEALTH. 61 

and avenge their wrongs upon an apathetic community 
by contributing to the causes of disease and death. 
The great " stink-factories " in the neighborhood of 
cities would then be closed for want of material on 
which to feed. 

Not only would butchers find the plan economic, 
but real estate in the vicinity of every place where 
slaughtering is done in towns would be enhanced in 
value. It is, indeed, necessary to supply the people 
with meat, but the supply should not be at the cost 
of discomfort to many and the depreciated value of 
homesteads. The supply can be cheaper without nui- 
sance than with it. 

XXXIX. 

In a city of one hundred thousand inhabitants 
there are about twenty thousand males of the dram- 
drinking age. If each of these were to spend five 
cents a day for a glass of beer, the expenditure would 
be $365,000 a year. If each spent ten cents daily for 
a drink of whisky, the yearly expenditure would be 
$730,000. If half took beer and half whisky, the 
amount spent would be $547,500 per annum. Some 
spend nothing in this way. Others drink a good deal 
more than a daily glass of beer or whisky. The sum 
spent in a city of one hundred thousand inhabitants in 
dram-drinking is more than $547,500 each year. Call 
it that. This sum is the interest at five per cent on 
$10,950,000. Such an expenditure would build and 
run all the schools and churches in the city. And 
the whole account is not thereby settled. Most dram- 



62 MAXIMS OF PUBLIC HEALTH. 

drinking places are nurseries of pauperism and crime, 
for the care of which the citizens must be taxed. 
Above all, dram-drinking is a bankrupt debtor to 
health. The late Dr. Parkes, a great authority in hy- 
giene, speaking from ample knowledge and without 
any temperance prejudices, says : 

" It does not appear to me possible at present to con- 
demn alcohol altogether as an article of diet. in health, 
or to prove that it is invariably hurtful, as some have 
attempted to do. It produces effects which are often 
useful in disease, and sometimes desirable in health ; 
but in health it is certainly not a necessity, and many 
persons are much better without it. As now used by 
mankind, it is infinitely more powerful for evil than 
for good ; and, though it can hardly be imagined that 
its dietetic use will cease in our time, yet a clearer view 
of its effects must surely lead to a lessening of the ex- 
cessive use which now prevails. As a matter of pub- 
lic health, it is most important that the medical pro- 
fession should throw its great influence into the scale 
of moderation ; should explain the limit of the useful 
power, and show how easily the line is passed which 
carries us from the region of safety into danger, when 
alcohol is taken as a common article of food." 

Thomas Carlyle, speaking of the laboring-classes 
in the city of Glasgow, thus describes the source of 
their greatest danger : 

" The sum of their wretchedness, merited or un- 
merited, welters, huge, dark, and baleful, like a Dan- 
tean hell, visible there in the statistics of gin — gin, 
justly named the most authentic incarnation of the 



MAXIMS OF PUBLIC HEALTH. 63 

Infernal Principle in our times, too indisputably an 
incarnation ; gin, the black throat into which wretch- 
edness of every sort, communicating itself by calling 
on Delirium to help it, whirls down ; abdication of 
the power to think, or resolve, as too painful now on 
the part of men whose lot, of all others, would require 
thought and resolution ; liquid madness sold at ten- 
pence the quartern, all the products of which are and 
must be, like its origin, mad, miserable, ruinous, and 
that only." 

Carlyle again touches the very quick of the ques- 
tion of " personal liberty " : 

"No man oppresses thee, free and independent 
franchiser ; but does not this stupid pewter-pot op- 
press thee ? No son of Adam can bid thee come and 
go ; but this absurd pot of heavy-wet, this can and 
does ! Thou art the thrall, not of Cedric the Saxon, 
but of thine own brutal appetites and this scoured dish 
of liquor ; and thou pratest of thy liberty ? Thou en- 
tire blockhead ! " 

The time is coming when any community will be 
ashamed to tolerate a place for public dram-drinking. 
The economic and sanitary gain will be immense. In 
this respect, also, Christian nations need to improve 
on the lesson taught by Mohammedans. 



XL. 

I once spent an entire autumn in the city of Ge- 
neva, Switzerland, in charge of an invalid patient. 
The climate, at that season of the year, was cold, raw, 



64 MAXIMS OF PUBLIC HEALTH. 

disagreeable. My heart was hungering in vain for 
Italy, " the land where the orange and the citron 
bloom." In order to tame my restless spirit, I read 
the " Institutes" of John Calvin and delved in the 
old cathedral archives, in order to glean any curious 
information about the period when the grim theologi- 
cal fatalist flourished. I found, among other things, 
that in his day Geneva had a visitation of the plague. 
A pest-house was built on the left bank of the Khone, 
a few miles below the city. Thither were taken the 
victims of the disease. To care for the sick, nurses 
were hired, whose pay consisted of whatever effects — 
clothing, jewelry, or money — were left by those dying 
of the deadly malady. When the plague began to 
abate, the nurses stole into the city by night and 
stealthily daubed the door-knobs with the infectious 
matter in order to obtain a new harvest of victims 
and increase their plunder ! 

Now, the aforesaid greedy nurses may be regarded 
as saints in comparison with the hell-brood of our times 
who address themselves, through newspaper advertise- 
ments, to the victims of "early indiscretions," of 
"seminal weakness," and of other ills that debauched 
human flesh is heir to. Such advertisements.are even 
found in the religious papers. Medical journals are 
not so depraved. Every male, from the dawn of pu- 
berty, needs proper instruction in the mysteries of life. 
Why generation after generation should be weakened 
by being left to the phallic teaching of chance and un- 
governed instinct is one of the unaccountable things 
of our pretentious civilization. The family physician 



MAXIMS OF PUBLIC HEALTH. 65 

is not always a wise instructor, and his advice is sel- 
dom sought. Fathers are not qualified to teach their 
sons, and avoid the subject. The victims of nervous 
diseases are multiplied, and we supplement the results 
of ignorance and vice with vast expenditures for asy- 
lums and hospitals. Medical hyenas explore the dark 
ways of society and fatten on the spoils of those dying 
of terror, if not of disease. 

Is there no remedy ? There are two remedies : 
sound knowledge ; an educated will. Get the best 
of all books on the subject, by William Acton, entitled 
" The Functions and Disorders of the Reproductive 
Organs, in Childhood, Youth, Adult Age, and Ad- 
vanced Life ; considered in their Physiological, So- 
cial, and Moral Eolations." It costs two dollars. 
There is no copyright protection for its publication 
in this country. It ought to be printed by the mill- 
ion, and sold as cheap as the New Testament. I have 
known wise mothers to buy it for their sons. Physi- 
cians might prescribe it, not unfrequently, for their 
male patients, old as well as young. It is invaluable 
for teachers to use among their pupils. It should be 
given out, with the admonitions of the gospel, from the 
confessional. Public hygiene must not be contented 
till it manfully, wisely, delicately occupies this ter- 
rible field. 



In a Western city a young girl of German parent- 
age, fourteen years of age, bright, beautiful, admired 
by her teachers, worshiped by father and mother, left 



66 MAXIMS OF PUBLIC HEALTH. 

school one afternoon without permission, was seen on 
the streets wearing a pallid, anxious, distracted look, 
and disappeared. The whole city searched for her in 
yain. The entire country was informed of her disap- 
pearance by the newspapers. Imaginary clews were 
followed from end to end of the land. Large rewards 
were offered for information concerning her. Detect- 
ives hunted for her in the highways and by-ways of 
cities. No ray of light penetrated the darkness of 
her parents' melancholy hearts. Impenetrable mys- 
tery brooded over her untimely fate. 

Some months afterward, when all search had been 
abandoned, the young girl's remains floated to the 
surface of a foul river in the city. It was a consola- 
tion to her stricken family to lay her body away in 
the grave, to rest in peace forever. Still the distress- 
ing problem of her death was not solved. 

It is painful to rend the veil covering this sad 
case, but the rending of it will reveal a lesson of price- 
less value to the living, and at the same time the les- 
son will vindicate and sanctify the memory of the 
beautiful dead. A few fortuitous hints, meaningless 
to non-professional people, significant to physicians, 
and a few wise mothers, afforded by her teachers and 
schoolmates, enable us to draw the dim outlines of a 
shadowy yet terribly tragic picture of real life. 

To all girls, sooner or later, comes the holy dawn 
of womanhood. It finds most, nearly all, ignorant, 
bewildered, alarmed. In the amazing unwisdom of 
our schools, they have been taught to conjugate 
irregular verbs and to find the rivers of heathen 



MAXIMS OF PUBLIC HEALTH. 67 

Africa, but have not been taught to know the course 
of the blood in their own bodies and to understand 
the natural functions of heart, lungs, brain, and other 
vital organs. The aurora of feminine life caught our 
poor girl untaught. The very nobility, sensitiveness, 
and pudor of her nature, with the nervous and men- 
tal disturbance incident to the period, undoubtedly 
led her to imagine, in her ignorance, that some awful 
and shameful calamity had overtaken her, of which 
she could speak to no one, not even to her mother or 
beloved lady teacher. It doubtless seemed to her 
bewildered mind that the only thing she could do to 
conceal her unspeakable and imaginary disgrace, to get 
rid of her loathed self, was to disappear unobserved 
and alone beneath the silent water of the inky river. 
The fate of Iphigenia, surrounded by her kingly 
father and the heroes of Greece, sacrificed in her 
innocence for a great public cause, was not half so 
tragic. In fact, the genius of tragedy, during all the 
ages, has never conceived anything so pathetic and 
terrible. 

The lesson to the living may be brief and direct. 
Most mothers, in the abundance of their own igno- 
rance, can not properly teach their daughters. Even 
wise fathers will not, ought not to, instruct those 
more precious to them than the blood of their own 
hearts, on such a delicate subject. Family physicians 
rarely have opportunities to give needed lessons. 
There is a little book, entitled "Hygiene for Girls," 
by Dr. Davis, which is the best that I know of on the 
subject. A father can give it to his daughter. A 



68 MAXIMS OF PUBLIC HEALTH. 

mother can read it with her child, and profit by it 
herself. A teacher can put it in the hands of her 
pupil. A lady can give it to a young friend. The 
hook contains information that will be greedily de- 
voured, like the bread of physical life. The knowl- 
edge it imparts will make a healthier, wiser, better 
generation of women. It will save broken bodies and 
tragic sorrow. By means of it, or in some other good 
way, instruct girls before puberty, ere the ills come 
that make calamity of too long life. 



"The protection of the public health," says 
Bishop ("Criminal Law," § 489), "is an interest of 
the first importance to every government. Without 
health, the members of the community can not dis- 
charge duties either to the government or to one an- 
other. Therefore, anything of sufficient magnitude 
for the law's notice, calculated to impair the public 
health, is indictable at the common law." 



XLIII. 

" The public health, the welfare and safety of the 
community, are matters of paramount importance, to 
which all the pursuits, occupations, and employments 
of individuals, inconsistent with their preservation, 
must yield " (Commonwealth vs. Upton, 6 Gray, 473, 
opinion by Merrick, J.). 



MAXIMS OF PUBLIC HEALTH. 69 



"While for obvious reasons," says Bishop (" Crim- 
inal Law," § 490), " a man is not punishable for be- 
ing sick of a contagious disease, in his own house, 
though the house stands in a populous locality, and 
while his friends are not guilty of crime in declining 
to remove him; yet, if the sick man goes out into the 
public way, carrying with him his infection to the 
danger of the public, or if one takes out an infected 
child, this act, at the common law, subjects the doer 
to an indictment" (Boom vs. Utica, 2 Barb., 104; 
Eex vs. Vantandillo, 4 U. and S., 73; Rex vs. Bur- 
nett, 4 U. and S., 272; 1 East P. 0., 226). 



"If a man has contagious disease in his house and 
fails to give due notice thereof, or allows people to 
come into his house without sufficient warning, or in 
any avoidable way exposes the public to contagion on 
his own premises, he is liable to indictment at the com- 
mon law" (Meeker vs. Van Eensselaer, 15 Wend., 397; 
State vs. Purse, 4 McCord, 472; People vs. Townsend, 
3 Hill, N". Y., 479; Welch vs. Stowell, 2 Doug., Mich., 
332; Moffett vs. Brewer, 1 Greene, Iowa, 348; Bar- 
clay vs. Commonwealth, 1 Casey, 503). 



Judge Dixon, of New Jersey, in a recent charge 
to the grand jury at Paterson, said : " If a man, con- 



70 MAXIMS OF PUBLIC HEALTH. 

scious that he carries about with him the germs of 
contagious disease, recklessly exposes the health and 
lives of others, he is a public nuisance and a criminal, 
and may be held answerable for the results of his 
conduct. If death occurs through his recklessness, 
he may be indicted for manslaughter. It is held that 
where a person knowingly communicates a contagious 
disease to another and death results, the crime is that 
of manslaughter." Judge Dixon added : " The man 
may be indicted also for spreading the disease by con- 
scious exposure of others thereto, by his presence in 
public places — such as on the streets, in halls, etc. 
He might be indicted as a public nuisance for en- 
dangering the public health in this way, even if no 
consequences had followed . The law provides some 
penalty for such offenses against the public safety " 
("Medico-Legal Journal," vol. i, No. 3, p. 394). 



The public has a right to demand that any prem- 
ises wherein there is contagious disease shall be con- 
spicuously placarded, under the direction of the sani- 
tary authority. The citizen, whose premises are thus 
placarded, is thereby shielded from criminal or other 
liability on account of the disease. Any one entering 
the premises is thus duly warned, and enters at his 
own risk and peril. The general principles that should 
govern the public management of contagious diseases 
have been very clearly laid down by Mr. Simon, whose 
long experience in England, as the head of the national 



MAXIMS OF PUBLIC HEALTH. 71 

public health administration, together with his con- 
spicuous ability, especially qualify him to speak au- 
thoritatively on the subject. "Probably the public 
good will be seen to require," says the great English 
sanitarian, " with regard to every serious infectious 
disease which is apt to become epidemic, that the 
peinciples which ought to be accepted in a really 
practical sense, and to be embodied in effective law, 
are somewhat as follows : 1. That each case of such 
disease is a public danger, against which the public, 
as represented by its local sanitary authorities, is en- 
titled to be warned by proper information. 2. That 
every man who, in his own person, or in that of any 
one under his charge, is the subject of such disease, 
or is in control of circumstances relating to it, is, in 
common duty toward his neighbors, bound to take 
every care which he can against the spreading of the 
infection ; that, so far as he would not of his own 
accord do his duty, his neighbors ought to have ample 
and ready means of compelling him; and that he should 
be responsible for giving to the local sanitary authority 
notification of his case, in order that the authority 
may, as far as needful, satisfy itself as to the suffi- 
ciency of his precautions. 3. That, so far as he may, 
from ignorance, not understand the scope of his pre- 
cautionary duties, or may, from poverty or other cir- 
cumstances, be unable to fulfill them, the common 
interest is to give him liberally out of the common 
stock such guidance and such effectual help as may 
be wanting. 4. That, so far as he is voluntarily in 
default of his duty, he should not only be punished 



72 MAXIMS OF PUBLIC HEALTH. 

by penalty as for an act of nuisance, but should be 
liable to pay pecuniary damages for whatever harm he 
occasions to others. 5. That the various commercial 
undertakings which, in certain contingencies, may be 
specially instrumental in the spreading of infection — 
water companies, dairies, laundries, boarding-schools, 
lodging-houses, inns, etc. — should respectively be sub- 
ject to special rule and visitation in regard of the 
special dangers which they may occasion ; and that 
the persons in authority in them should be held to 
strict account for whatever injury may be caused 
through neglect of rule. 6. Finally, that every local 
sanitary authority should always have at command, 
for the use of its district, such hospital accommoda- 
tion for the sick, such means for their conveyance, 
such mortuary, such disinfection, establishment, and 
generally such planned arrangements and skilled ser- 
vice as may, in case of need, suffice for all probable 
requirements of the district" (Quain's "Dictionary 
of Medicine," p. 293). 



So far as the public sanitary agency is concerned, 
contagious and infectious diseases may be divided into 
two classes : (a) those that may be allowed to run their 
course, under the exclusive management of the family 
and the physician, and (b) those that should be com- 
bated under regulations provided by law to prevent 
their spread. In the first class may be reckoned 
chicken-pox, mild measles, whooping-cough, etc. In 



MAXIMS OF PUBLIC HEALTH. 73 

the second class may be reckoned small -pox, scarlet 
fever, diphtheria, typhus fever, enteric fever, cholera, 
etc. It is not often that we have all the graver con- 
tagious and infectious diseases prevailing at the same 
time. 

Some infectious diseases require to be regarded in 
the first or second class, according to the type of a 
prevailing epidemic. Sometimes a malignant form 
of measles prevails, when, for a period, it would be 
necessary to apply all the machinery of repression. 
Ordinarily, measles are not very dangerous, and, as the 
disease is inevitable sooner or later, and is less fatal 
in childhood than in advanced age, it is better to let 
it take its course. When scarlatina is of a very mild 
type, it would be as well to let it run, but for the very 
important fact that susceptibility and danger rapidly 
decrease after the first dozen or fifteen years of life. 
Enteric fever also becomes rarer and rarer after thirty 
years of age, and does not exist at all after forty-five 
or fifty. As one attack does not exempt from fu- 
ture attacks of diphtheria, the disease is always to be 
combated. It is not easy to decide when and to what 
extent the health authority should interfere in the 
execution of measures to suppress communicable dis- 
eases. In all cases, private and public effort should 
be intelligently combined in struggling against these 
foes of mankind. And sanitary officers should always 
be clothed with authority, expressed or implied, to 
use discretion in the enforcement of measures for pre- 
venting the spread of contagious and infectious dis- 



74 MAXIMS OF PUBLIC HEALTH. 

There is no fact better established than this, to 
wit, that all epidemic diseases are increased in viru- 
lence by conditions of filth and unwholesome habits 
of life. While the public health authority can do very 
little in regard to the manner of living among the 
people, it can do a great deal in the way of removing 
and preventing unsanitary conditions. All effort in 
that direction tends to destroy the food on which epi- 
demic diseases feed. The channels through which 
contagious germs travel from person to person are nu- 
merous, and therefore the work of the health author- 
ity can not well be too comprehensive. 

Isolation and disinfection, together with vaccina- 
tion as preventive of small-pox, constitute the funda- 
mental principles of such methods. The aim is to 
prevent as far as possible exposure of the non-infected 
to the infected, to close up the channels through which 
contagion is conveyed from the sick to the well, and 
to destroy the accumulations of disease-germs wher- 
ever they can be reached. Here, again, it is not easy 
to determine the best means and the least annoying 
ways. It is not at all difficult to find fault, without 
any obligation or inclination to suggest something 
better. 



The proper person to report a case of infectious 
disease to the sanitary authority is the attending phy- 
sician. The householder should also be required to 
report, if there is no physician in attendance. The 
police power of the State is ample to require such a 



MAXIMS OF PUBLIC HEALTH. 75 

service to the public, both from physicians and house- 
holders. Members of the medical profession have 
sometimes objected to the performance of such serv- 
ice without compensation. In many places compen- 
sation is provided for, but the legal obligation does 
not rest upon the compensation ; in that case the prac- 
titioner could forego the compensation and refuse to 
perform the service. All citizens can be required by 
the State to make reasonable sacrifices for the public 
good. Doctors are not exceptions to the rule. The 
objection has sometimes been made to statutes and 
ordinances requiring physicians to report cases of con- 
tagious diseases to the sanitary authority, that it in- 
volves the betrayal of the secrets of patients, and con- 
sequently a violation of professional honor. Just as 
though the fact that a man has small-pox, cholera, or 
some other pestilential disease could, or ought to be, 
a matter of secrecy between his physician and himself ! 
Just as though a man had a right to violate just law 
by exposing others to his deadly communicable dis- 
ease, and to require his medical attendant to become 
a particeps criminis by refusing to reveal it to the 
proper public authority ! The medical oath has no 
such meaning. It might just as well be claimed that 
a surgeon ought not to testify before a criminal court 
concerning a wound received by a burglar in the act 
of breaking into a house. The American profession 
has never disgraced itself by seriously raising such an 
objection. 

In this delicate matter, physicians should, as a rule, 
be treated with confidence by the sanitary authority. 



76 MAXIMS OF PUBLIC HEALTH. 

A medical practitioner, in obedience to law, and in 
good faith, reports to a health-officer a case of infec- 
tious disease. If the health-officer were to go and 
inspect the case, re-diagnose the disease, and perhaps 
reverse the decision of the practitioner, and put the 
whole matter on public record, it would be a profes- 
sional outrage, a piece of personal presumption — in 
fact, an official injustice. To send an inspector to do 
the same thing would be at least equally reprehensi- 
ble. Still, the sanitary authority should always reserve 
to itself the right to investigate a case of real infec- 
tious disease concealed by either ignorance or fraud. 



Every case of infectious disease should be reported 
to the sanitary authority ; then the sanitary authority 
should conspicuously placard the place where such 
case of infectious disease exists ; schools should be no- 
tified of the case, and all children from the house re- 
jected from school, till the case terminates and danger 
from " coming down " with the disease terminates ; the 
inmates of the house should be prohibited from going 
out to engage in occupations in company with others ; 
when such a case terminates in death, the undertaker 
having charge of the burial of the remains should not 
be allowed to take the corpse to a church or other 
public place for a funeral, to open the coffin for a view 
of the remains at the private funeral, or to allow young 
persons to act as pall-bearears ; and when the case ter- 
minates by recovery or death, the premises should be 



MAXIMS OF PUBLIC HEALTH. 77 

thoroughly disinfected under the supervision of the 
sanitary authority, and at the same time the disin- 
fector, who ought to be an educated physician, should 
make a thorough examination of the premises for any 
sanitary defects, which should be clearly reported, if 
any are found, to the health-officer, to be dealt with 
under the law of nuisance. I have successfully car- 
ried out such a system in Milwaukee and Detroit, over 
a period of six years, and can speak somewhat posi- 
tively of the results. Its advantages may be briefly 
stated : 

1. It enables the health department, and the pub- 
lic through the health department, to know every 
day in the year the exact number of cases of infec- 
tious diseases in a city and their precise location. 
Rumor and sensational exaggeration in regard to the 
prevalence of contagious maladies, which are liable to 
alarm the people needlessly and to interfere with the 
pursuits of life, can then be corrected by facts. And 
the truth of a violent epidemic can not be suppressed 
in the interest of commerce, to the criminal endanger- 
ing of the outside world. 

2. The exact percentage of mortality is constantly 
known, revealing the severity or mildness of an epi- 
demic. 

3. The system affords especial means of studying 
the conditions under which contagious diseases flour- 
ish, or to what extent they are influenced by sanitary 
surroundings. 

4. It diminishes the spread of contagious diseases 
by protecting large congregations of children in 



78 MAXIMS OF PUBLIC HEALTH. 

schools from the presence of those bearing infection 
in their persons or clothes; by preventing exposure of 
the living at public funerals; by revealing to all who 
can see and read the places where such diseases may 
be caught, and by destroying the lingering germs of 
contagion in sick-rooms by means of thorough dis- 
infection. My experience convinces me that a com- 
munity will give a wide berth to small-pox, scarlet 
fever, or diphtheria if you will only let them know 
where it is. I have frequently seen quite small chil- 
dren cross over to the other side of the street when 
approaching a house on the door of which was placed 
a placard revealing the existence of contagious disease 
within. It is wicked to conceal from God's little ones 
the fountains of infectious suffering and death. 

The difficulties of carrying out the system are con- 
siderable, but not insuperable: 

1. While the majority of educated physicians are 
ready to co-operate with the health authority in carry- 
ing out any reasonable system of protecting the public 
from contagious diseases, the negligence of some and 
the perversity of a few must be overcome by the un- 
flinching execution of the law. The medical prac- 
titioner depends upon the patronage of the public, 
and should be willing to do for the public at large a 
service that costs very little time and trouble, and is 
attended with no expense. The necessity of reporting 
to the health-office all deaths, with the causes, in 
order to get a permit to bury, puts the doctor on his 
good behavior. A few attempts to return croup for 
diphtheria, spotted fever for scarlatina, etc. , may be 



MAXIMS OF PUBLIC HEALTH. 79 

met with an order for a coroner's inquest. Inability 
to make a diagnosis has sometimes been urged as an 
excuse by delinquent quacks, but an unmistakable 
indication of criminal prosecution soon reveals to 
them that the responsibilities of assumed knowledge 
can not be voided by a plea of ignorance. In some 
instances doctors prematurely report recovery. The 
law of duration in contagious diseases is too well 
known to allow such heedlessness to escape notice and 
rebuke. It is sometimes disagreeable to supplement 
the mental and moral defects of a portion of the pro- 
fession by the terror of criminal law, but faithful sani- 
tary administration requires it. 

2. At first the people object to having their houses 
placarded, as a violation of personal liberty. A little 
argument convinces reasonable citizens that no man 
has the natural or acquired right to expose his neigh- 
bors to deadly contagious disease by concealing it in 
his own house. Personal liberty to give small-pox to 
somebody else had better be abridged as soon as pos- 
sible. Personal liberty to send scarlet fever into a 
school with your child is rather diabolical than be- 
neficent. Personal liberty to infect a church with a 
diphtheria-corpse is tempting Providence to start an 
epidemic. A law-abiding community will submit, 
and soon the system of placarding, if it were left to 
an election, would receive a majority of votes in its 
favor. Experience proves its value in many ways to 
the citizen. He knows and feels that, by reason of it, 
his family is more secure against diseases that cost 
money, anxiety, and sorrow. 



80 MAXIMS OF PUBLIC HEALTH. 

The defects of the system are already apparent to 
educated sanitarians : 

1. So far as small-pox is concerned, proper vacci- 
nation and re vaccination at suitable ages should be 
universal and compulsory. I am sorry to say that, in 
this respect, the sanitary code of most cities is defect- 
ive. Without vaccination, suppression of the disease 
allows the greater accumulation of material for the 
conflagration of an epidemic, that sooner or later may 
get under way and defy all control. Every escape 
from scarlet fever is a positive gain, for susceptibility 
to the disease decreases with age. Diphtheria should 
be suppressed all the time, for one attack does not 
secure immunity in the future. 

2. The efficiency of the system depends to a great 
extent on the willing or enforced co-operation of the 
medical profession. Just so far as the profession falls 
short of an ideal standard must the system fail to 
reach its ideal value, however well it may be adminis- 
tered. 

The system in every place should be supplemented 
by a pest-house, to which the sick with contagious 
diseases, who have no homes, can be taken. With an 
efficient system of placarding and isolation, it is more 
economic, more humane, if not safer, to leave patients 
who have homes under the care of their families and 
friends. However excellent a hospital and its service 
may be, households are unwilling to give up any of 
their sick members to be nursed by unknown hands 
in a strange place. To force away children from par- 
ents, from brothers and sisters, and parents from 



MAXIMS OF PUBLIC HEALTH. 81 

children and from one another, for the purpose of iso- 
lating infectious disease, exposes the public by trans- 
portation of the afflicted, diminishes the chances of 
recovery, outrages the unreasoning affections, and in- 
vades the sanctity of home. Sanitation must reckon 
with the unalterable instincts of humanity, and re- 
strain itself within the boundaries of reasonable en- 
deavor. 

Therefore, in my judgment, the isolation of con- 
tagious and infectious diseases in the family, which is 
the unit of our political society and Christian civili- 
zation, is wisest and best. After long administrative 
training we shall get the willing co-operation of house- 
holds and their chosen physicians. The day will come 
when exposure of others to our diseases will be recog- 
nized as a crime, the punishment of which will be de- 
manded by the public conscience. 

In the mean time we must combat superstition, 
diffuse rational knowledge, and protect the people 
against pestilence by the simplest and most effective 
means at our command, winning confidence by pa- 
tient, kindly instruction, only using repression and 
the lash of the law when we must. 

For the prevention of infectious diseases we are 
sadly in need of intelligent and trained private en- 
deavor, as a supplement to public sanitation. Would 
that the clergy, taking for texts the hygienic precepts 
of Moses, which have not been surpassed by the reve- 
lations of modern science, might preach the gospel of 
cleanliness, and thus open up to their people new 
avenues of godliness ! Would that we had in every 



82 MAXIMS OF PUBLIC HEALTH. 

city a society of devoted men and women, like the 
Order of the Eed Cross, whose especial duty it should 
be to go into the by-ways, not far from their own 
doors, and save from the perils of contagion and filth 
a greater number who perish, year by year, in times 
of peace, than ever die on the fields of battle in times 
of war! "Meanwhile," says the venerable Edwin 
Chad wick, the father of sanitation in England, " un- 
til justice is reclaimed for the administrative service 
in behalf of the public, as much as possible should be 
called for by appeal for voluntary effort. Of what 
this may do in preventing the spread of the ordinary 
foul-air epidemics, I will state the experience of a 
nurse of twenty years' practice, as a specialist in deal- 
ing with the most infectious and dangerous of them, 
namely, scarlet fever. Her chief practice was the 
common one in respect to all cases of the varied epi- 
demics : to isolate the patient in a single room, the 
upper room, if possible, and let no one else enter it ; 
to so arrange as to keep the door and part of the win- 
dow open in order to let a current of air pass through 
the room over the patient ; to observe all the details 
of regulations as to the cleanliness of the patient and 
the articles of clothing and furniture, and the removal 
of excreta, etc. ; and as to her own personal protec- 
tion, never to drink out of the same vessel that had 
been used by the patient, and to wash from head to 
foot twice a day with tepid water, and to change her 
clothes each day. With these precautions, she had 
never had a single case of the spread of the disease to 
a member of the family or any one else during the 



MAXIMS OF PUBLIC HEALTH. 83 

twenty years, nor had she once contracted the disease 
herself." 



Criminally careless physicians sometimes go from 
the bedside of patients laboring under contagious dis- 
eases, without disinfecting themselves, to see other 
patients, and may forget themselves so far as to fol- 
low the dirty and dangerous habit of kissing the baby. 
Mothers ought to punish them by pouring hot water 
on them long enough to disfigure them for life. If a 
doctor consciously exposes an innocent and confiding 
household in that way, he ought to be scalded to death. 
Law ought to be enacted making homicide excusable 
in such case. Heedlessness is not a valid excuse, and 
should be visited with the penalty of maiming, as a 
perpetual reminder. Lawyers are in the habit of des- 
canting upon the case of Burke, who murdered people 
for the purpose of selling their dead bodies to the dis- 
sectors, as exhibiting the acme of human depravity 
and wickedness. Burke was a Christian and a gentle- 
man in comparison with the medical fiend who con- 
nives at the spread of infectious disease in order to 
increase his practice. 



Don't use patent disinfectants. They are all dear. 
Many of them are worthless. But few of them are 
effective. They are not only expensive, but may also 
be a delusion and a snare. 



84 MAXIMS OF PUBLIC HEALTH. 

The best of all disinfectants is fire. Burn up dan- 
gerous things if you can. All rags and remnants of 
food that have been in contact with patients afflicted 
with diphtheria, scarlatina, cholera, or other infec- 
tious diseases, should be thrown promptly into the 
fire. Do not leave them about to add to the volume 
of poison generated in the sick-room, or to be handled 
by the ignorant or unwary. A large part of garbage, 
that would soon putrefy and become dangerous, may 
be burned, when there is no other ready means of its 
disposal. 

Heat is akin to fire. All washable clothes, for the 
person or beds, may be disinfected by boiling. Cook 
the germs of disease, and they will never sprout or 
hatch. Every household, however poor, can command 
boiling water. Don't lay aside sheets, towels, pillow- 
cases, pocket-handkerchiefs, night-gowns, or other ar- 
ticles of the kind, that have been in contact with the 
sick, to be washed at a convenient or leisure time, but 
boil them for an hour or two at once. Few house- 
holds have conveniences for disinfecting with dry heat. 
Articles that can not be boiled without spoiling, may 
be safely and effectively baked at a temperature of 
240° Fahr. As I have said elsewhere, the best of all 
means for disinfecting ships is dry steam. 

Next in general value is fresh air — plenty of it, in 
constant currents. Sunlight should be abundantly 
mixed with it as an adjuvant. The oxygen of pure 
air kindles a slow fire in all filth with which it comes 
in contact. Ozone, sometimes abounding in the at- 
mosphere, is still more potent. Cover up, head and 






MAXIMS OF PUBLIC HEALTH. 85 

all, your poor patient, languishing with infectious 
disease, and throw wide open, for a minute or two 
every window and door of the chamber, at least once 
an hour. It is not only good for the sick, but also 
lessens the danger to the attendants. 

The really useful chemical disinfectants are few in 
number;, and for the most part very cheap. Chlorine 
gas is the most potent, but is dangerous to use, and 
may be passed by. Nitrous-acid gas is next in potency, 
but is also too dangerous. Sulphurous-acid gas is 
sufficiently effective, and may be safely managed with 
care. Close a room tight, and burn in it one pound 
of sulphur for every thousand cubic feet of air-space. 
A room fifteen feet square and twelve feet high would 
require nearly three pounds. Carpets that have not 
been removed during sickness with contagious disease 
should be left down, blankets and mattresses should 
be hung over chairs, while disinfection is going on. 
The sulphurous-acid gas will kill plants and birds, 
and you, too, if you attempt to stay in the room. 
Leave the room closed at least three hours, and then 
air it out. Be careful not to set fire to the house, or 
burn a hole in the carpet. Fill a coal-scuttle or deep 
pan half full of coal-ashes, put on the ashes some live 
coals, and then put the brimstone on the coals. A 
public disinfector will find a mixture of seven parts 
of flowers of sulphur, two parts saltpeter, and one 
half part of camphor, intimately ground together, 
most convenient, for it will freely burn in paper pack- 
ages without the coals, which are not always con- 
venient to obtain. A skilled disinfector can save all 



86 MAXIMS OF PUBLIC HEALTH. 

household articles, -without risk, even after small-pox, 
by means of sulphurous-acid gas. 

Add to this invaluable aerial disinfectant acetic 
acid, hydrochloric acid, corrosive sublimate, and cop- 
peras, for other purposes, and we need not bother our- 
selves about the rest. Carbolic acid, so called, which 
is no acid at all, is not only a delusion, but it betrays 
by false promises. It is an excellent antiseptic, but is 
not a disinfectant. 

Acetic acid is a precious disinfectant. The best 
form of it — the glacial aromatic acid — is very costly, 
and can be used only by the rich. Common vinegar 
— another form of it — is very cheap, and is found in 
every household, however poor. Everybody has heard 
of the four thieves, who, during the plague of Mar- 
seilles, plundered the dead without infection. They 
were condemned to death, but were promised immu- 
nity if they would reveal the means whereby they es- 
caped infection from the plague. 

Their security was simply from the use of aromatic 
vinegar, which, for this reason, is sometimes still called 
in France " le vinaigre des guatres voleurs " — the vine- 
gar of the four thieves. Cardinal Wolsey protected 
himself from the infection of the crowd by a sponge 
filled with vinegar, carried in an orange-peel. A dish 
of vinegar, into which has been thrown a handful 
of aromatic herbs — rue, rose-leaves, etc. — evaporating 
over a lamp or on a stove in a sick-room, is a powerful 
disinfectant, and greatly aids protection of the attend- 
ants from contagion. It is not so efficacious as burn- 
ing little pinches of sulphur every hour throughout a 



MAXIMS OF PUBLIC HEALTH. 87 

house in which are patients with infectious disease, 
but is the next thing to it. 

There is nothing better than hydrochloric acid, 
one part to twenty of water, for disinfecting the excre- 
ta of cholera and typhoid patients, and, in general, of 
all patients laboring under contagious and pestilential 
diseases. Body and bed clothes, contaminated by such 
patients, may be soaked in it, if opportunity for boil- 
ing the same be wanting. A solution of corrosive 
sublimate, half a drachm to the gallon of water, is a 
good substitute for diluted hydrochloric acid. It is 
objected to corrosive sublimate that it is a virulent 
poison. The same objection might be urged to hydro- 
chloric acid. Neither should be intrusted to children 
and fools. An astonishingly small quantity of cor- 
rosive sublimate in water will devitalize germs, both 
animal and vegetable, as elaborate experiments in Ger- 
many have recently proved. 

It must not be forgotten that deodorizers are not 
always disinfectants. On the other hand, disinfect- 
ants are not always deodorizers. A solution of cop- 
peras, one pound to the gallon of water, is a cheap 
deodorizer, and a very good disinfector of foul drains 
and cesspools. As Professor John Dougal, of Glasgow, 
has abundantly demonstrated, acids change the process 
of putrefaction into the less dangerous process of fer- 
mentation, and must be chiefly relied on as chemical 
disinfectants. Experience proves that a majority of 
physicians, educated to cure, not to prevent, disease, 
know as little about disinfection as other people. 
Only the other day a busy practitioner of medicine 



88 MAXIMS OF PUBLIC HEALTH. 

informed me, in good faith, that he had just thor- 
oughly disinfected a house after diphtheria by carry- 
ing around from room to room a pan of coals with an 
ounce of surphur burning thereon, and did not quite 
comprehend the sarcasm of the inquiry, whether he 
thought he could stand more sulphurous-acid gas than 
a bacterium termo. 



Lin. 

The venerable Edwin Chadwick sums up the fruit- 
ful sanitary experience of half a century in the fol- 
lowing conclusions : 

"That cases of small-pox, of typhus, and of others 
of the ordinary epidemics, occur in the greatest pro- 
portion, on common conditions of foul air, from stag- 
nant putrefaction, from bad house-drainage, from 
sewers of deposit, from excrement-sodden sites, from 
filthy street surfaces, from impure water, and from 
overcrowding in foul houses ; 

" That the entire removal of such conditions by 
complete sanitation and by improved dwellings is the 
effectual prevention of diseases of those species, and 
of ordinary as well as of extraordinary epidemic visi- 
tations ; 

"That where such diseases continue to occur, 
their spread is best prevented by the separation of the 
unaffected from the affected, by home treatment if 
possible ; if not, by providing small temporary accom- 
modation ; in either case obviating the necessity of 
removing the sick to a distance, and the danger of 



MAXIMS OF PUBLIC HEALTH. 89 

aggregating epidemic cases in large hospitals — a pro- 
ceeding liable to angment the death-rates during epi- 
demics ; 

" That skillful and complete works of sanitation 
and the removal of the conditions of stagnancy and 
putrefactive decomposition, are the most efficient 
means of reducing the expenses of excessive sickness 
and death-rates."* 



LIV. 

It is impossible, with any reasonable outlay, to 
inspect all meat sold in many places scattered over a 
city. Besides, the inspection of animals before they 
are slaughtered is even more necessary than the in- 
spection of meat. If all slaughtering were done at an 
abattoir, one experienced and skilled man could inspect 
an immense amount of stock when ready to be killed. 
Diseased, maimed, feverish, or over-wearied animals 
could be sorted from the healthy. Doubtful animals 
could be marked and the vital organs of such might 
be examined after slaughtering, in order to determine 
their fitness for human food. Good butchers would re- 
joice in such a course by the public sanitary authority, 
for they have no inclination to supply the people with 
unwholesome meat. Those who thrive by swindling 
the ignorant and the poor, at any cost to the health 
or even life of their victims, would find their occupa- 
tion gone, and turn their attention to some less guard- 
ed field of industry. The whole community would 

* Address before the British Health Congress, December, 1881. 



90 MAXIMS OF PUBLIC HEALTH. 

be protected against the purchase of unsound meat. 
When it is remembered that the foul tape-worm 
comes from eating "measly" pork; that the deadly 
trichina comes to the human stomach from the flesh 
of swine ; that sheep and cattle are liable to chronic or 
acute diseases which render their flesh unwholesome 
or dangerous to man; that unprincipled butchers 
slaughter animals too young or too lean for food — it 
will be acknowledged that intelligent and conscien- 
tious inspection is a great safeguard to the public. 
Professor Gamgee, speaking of the maladies of cattle, 
says : " Many of the worst forms of disease are very 
sudden, and only slightly affect the color and texture 
of the muscular apparatus. A fine, fat bullock, with 
florid meat, may have died from splenic apoplexy, or 
been merely killed pro forma, when already on the 
point of death. Remove the spleen, and the carcass 
appears sound. Yet dogs and pigs die from eating, 
although first cooked, any portion of such cattle." It 
is known that a poison is very rapidly generated 
throughout the entire system of a severely bruised 
animal, yet such are slaughtered for the market and 
sold to the sausage-maker, if not to the dispenser of 
fat beef. Half-dead animals mysteriously disappear 
from stock-yards, and nobody seems to know where 
they go. If the meat-supply of a city were confined 
to an abattoir, where all stock must be inspected be- 
fore slaughtering, the dangers would be removed. 



MAXIMS OF PUBLIC HEALTH. 91 



What are the objections to slaughtering - places 
in a city ? Ask the people who live in their vicinity, 
and they will answer with an eloquence inspired by 
the perpetual discomfort of noise and stench, and by 
the depreciation in the value of their homes. The 
driving of cattle to such places is a danger and an 
obstruction to the public streets. The noise of ani- 
mals, by night as well as day, irritates the nerves and 
destroys sleep. Women and children can not help 
seeing from windows opening upon uncovered slaugh- 
ter-yards, here and there in a city, the butcher plying 
his trade. To many it is a distressing sight. Scenes 
of brutality are sometimes witnessed that shock all but 
the hardened. The murderous axe and the knife red 
with blood are not suggestive of the humanizing sym- 
pathies. The smell of offal, even when it is untainted, 
is repulsive ; and windows on the side of the slaugh- 
ter-house must be closed in summer, when fresh air is 
needed. The yards where animals destined to slaugh- 
ter are kept, become foul with excreta and send up 
poisonous exhalations. Not unfrequently the refuse 
of slaughtering putrefies before it can be removed, 
and adds to discomfort a source of disease. The plain- 
tive cry of dumb creatures, that seem to have an in- 
stinct of their fate, sounds mournful to the human ear, 
and tempers hearts to sadness that might otherwise 
be glad. 

The depreciation of real estate in the neighbor- 
hood of slaughter-houses amounts to much more than 



92 MAXIMS OF PUBLIC HEALTH. 

the whole value of a business that might be conducted 
more profitably elsewhere. In some places the depre- 
ciation is fully one half. Butchers have no right to 
tax their fellow-citizens so heavily for their own con- 
venience. A meat-market is not offensive ; when kept 
clean and neat, it is even attractive. But no care can 
make a slaughtering-place anything but a nuisance. 



By concentrating the slaughtering-business of a 
city, subject to expert inspection, a great deal of cru- 
elty to the dumb creatures on which we feed might be 
prevented. There is no doubt that driving cattle, and 
especially swine, sorely tries the temper. But the 
seeming perversity of an excited, wearied, bewildered 
animal, on its unknown death-march to sepulture in 
the human stomach, is no excuse for brutality in man. 
I have seen creatures, that walk on two legs and wear 
clothes, stabbing cattle and swine with a pike, inflict- 
ing wounds never to be healed. The pole, in the end 
of which the pike is fixed, sometimes equals in length 
and size the handle of a pitchfork. The pike -end 
of it is protected from splitting by a heavy ferule of 
iron or brass. The drivers not unfrequently stab and 
maul the poor creatures with this formidable instru- 
ment of savage warfare, till they are bruised and 
pierced into a condition unfit for slaughter. 



MAXIM 8 OF PUBLIC HEALTH. 93 



"We owe it to the dumb creatures that are helpless 
and unable to plead for themselves, to kill them as 
painlessly as possible, when we slaughter them for 
food. The English poleaxe is a much better instru- 
ment of death than a sledge-hammer. In France and 
Germany, the bouterolle a la masque, Schlachtmaske, 
"slaughtering-mask," has been invented and hu- 
manely used. It consists of a hood, which is thrown 
over the animal's face, provided with a circular iron 
plate, that rests upon the forehead, between the eyes ; 
in the center of the plate is a steel punch, which can 
be driven into the brain by a single smart blow with a 
hammer. If necessary, an iron rod may then be used 
to break up the base of the brain by thrusting it into 
the perforation. A German newspaper sums up the 
advantages of the mask as follows : " 1. The duration 
of suffering is reduced to almost nothing. 2. The 
flesh and internal organs are in better condition. 

3. The brain is natural in appearance, not congested. 

4. Less strength and less exposure to danger of being 
injured are necessary on the part of the butchers. " * 

If all slaughtering for a city were done in a suit- 
able abattoir, with proper appliances, and under the 
eye of an inspector, the brutalities complained of 
would become unknown. There are human beings 
who even take pleasure in the dying-agonies of ani- 

* See Dr. Folsom's article in the " Sixth Annual Report of the 
State Board of Health of Massachusetts," p. 181, where he gives a 
woodcut of the instrument. 



94 MAXIMS OF PUBLIC HEALTH. 

mals. Cruelty to the brute creation reacts and pro- 
duces its harvest of inhumanity and violence to soci- 
ety. The youth who grows merry over his awkward 
and ineffectual blows at the head of a bullock with a 
sledge-hammer is educating himself to brutal treat- 
ment of his fellow-men. And Nature swiftly breeds 
poison in every fiber of the terrified, enraged, and 
abused beast, wherewith to punish a community of 
beef-eaters for their ignorant or criminal indifference. 

LVIII. 

A competent eye-witness, writing to the "New 
York Tribune" from Chicago, thus describes the 
shocking cruelty practiced upon animals in transit : 

" Some idea of the condition of the animals on 
arriving at Chicago may be formed when it is known 
that the dead hogs average fully one to a car-load, 
and this when the weather and other conditions are 
favorable, while a careful inspection of the books of 
the railroads shows that the dead cattle, including 
those which are so badly crippled as to have no 
greater commercial value than if dead, average about 
five per day. These dead animals include only those 
which have died since leaving the last preceding feed- 
ing-station, where the dead and badly wounded were 
not reloaded. If, by a supreme effort, induced by 
extreme torture and a desire to accompany its com- 
panions, the animal can rise to its feet and leave the 
car, the animal is classed as sound. I saw a poor 
creature, after repeated and most desperate efforts, 



MAXIMS OF PUBLIC HEALTH. 95 

succeed in rising to its feet, after it had been dragged 
from the car, and, trembling violently in every part 
of the body, it was finally able to follow its compan- 
ions. The shouts and thrusts of the attendants in 
another car that had just arrived at the yards had no 
effect upon a steer which had been forced down and 
trampled upon by its comrades until it was severely 
wounded ; but a dexterous twist of the tail, giving a 
violent shock to the spinal column, started the ani- 
mal, and it made a last desperate effort to rise, but in 
vain, and further twisting of the tail and kicks and 
shouting were of no avail. Unable to hold its head 
up longer, it submitted quietly to all the cruelty that 
was practiced upon it. It was dying. The records 
show that the number of those that reach the Chicago 
yards in this condition is greater than that of the 
actually dead. Broken horns, with the blood drip- 
ping from them, and other evidences of injury, are 
seen on almost every train." 



LIX. 

Mr. Henry Bergh (who could not, if he would, 
speak with exaggeration on this subject) truly says : 

" The truth should be known to the consumers 
of the flesh of sick and dying animals, starved and 
pounded during a journey of many days' duration. 
On arrival at their places of destination, they are at 
once driven into the slaughter-houses, almost frantic 
from the consequences of the treatment which so- 
called civilized beings have made them endure, burn- 



96 MAXIMS OF PUBLIC HEALTH. 

ing with fever, lame, and coyered with deep-sunken 
ulcers, and they are killed and dressed for the market; 
and, horrible to think of, the meat is perhaps on the 
next day placed upon the tables of the citizens and 
restaurants of the city, and eaten and absorbed by its 
apathetic or unsuspecting consumers. Familiarity 
with these soulless and disgusting proceedings has 
almost converted the writer into a strict vegetarian. 
He has seen the carcasses of animals suspended in the 
abattoirs in and around New York, awaiting trans- 
portation to the markets, which exhibited revolting 
sores and ulcers, sometimes a foot in diameter." 

In answer to the question, "What are you going 
to do about it ? " Mr. Bergh says : 

"Three remedies are practicable in case the people 
see fit to wake up from their slumber : 1. Eebellion 
against the railroad tyrants by forcing a stringent 
law through Congress compelling these corporations 
to change this system of cattle transportation entirely, 
and placing the enforcement of that law either in the 
hands of government officials, or in those of the so- 
cieties for the prevention of cruelty to animals, along 
the whole route of transportation, reimbursing them 
their expenses. 2. By obliging stock-companies to 
slaughter the animals near their grazing-grounds, and 
bring the meat to market in refrigerator-cars. 3. In 
case these are not attainable, the refraining from the 
use of meat altogether." 

There is another remedy which Mr. Bergh does 
not mention. Every city should be provided with 
one or more public abattoirs, in the open country ad- 



MAXIMS OF PUBLIC HEALTH. 97 

joining, to which are attached wide fields for sum- 
mer and vast sheds for winter use, in which cattle 
can be fed and cared for in a humane way, until they 
entirely recover from the fever, injuries, and fright 
of a long journey, before they are slaughtered for 
food. Whether the cattle arrive in cars or in droves, 
they should be kept, under conditions of health, until 
a skilled inspector pronounces them fit for slaughter. 



The police power of a State inheres in its sov- 
ereignty, and is ample to establish abattoirs, even 
exclusive abattoirs (" Slaughter- Ho use Cases," 16 
Wall., 36). "In Louisiana," to use the language of 
Judge Cooley, " the State went so far for the protec- 
tion of New Orleans against the customary evils of 
slaughter-houses as to give to a company of individ- 
uals a monopoly of the slaughtering of cattle for the 
market — an exercise of power that at first blush is 
startling ; but it has been fully sustained by State 
and Federal authorities" ("Michigan State Board 
of Health Eeport," 1882, page 14). 

No man need suffer unreasonably from a slaughter- 
house in proximity to his habitation, for the common 
law furnishes him a remedy. " Slaughter-houses are 
regarded as prima facie nuisances, and their existence 
so near to dwellings as to impair their comfortable 
enjoyment is an actionable injury" (Wood's "Law 
of Nuisances," second edition, page 657). All the 
sufferer has to do is to employ a good lawyer, and 



98 MAXIMS OF PUBLIC HEALTH. 

prosecute the owner of the slaughter-house in private 
damages. " So far as injuries to private rights are 
concerned, parties are usually left to their common- 
law remedies" (ibid., page 663). 



LXI. 

There is but one proper remedy for the adultera- 
tion of foods and drinks, and that is to apply the ex- 
isting criminal law to the adulterators. If a manu- 
facturer or dealer mixes glucose with cane-sugar, and 
sells the mixture as pure sugar, apply to him the 
statute of fraud. If a dairyman waters his milk, and 
sells the resulting fluid as pure milk, treat him as a 
swindler. If a baker puts alum in his bread, to con- 
ceal poor flour, treat him as one knowingly adminis- 
tering that substance for the purpose of causing all 
the results produced by it. If the brewer puts in his 
beer carbonate of soda, lime, copperas, sulphuric acid, 
aloes, colocynth, santonin, cocculus Indicus, nux vomi- 
ca, strychnine, tobacco, picric acid, copper, lead, or 
other deleterious substance, apply to him the criminal 
law against administering poisons with intent to in- 
jure or kill. If an importer puts upon the market 
green teas "faced" with Prussian blue, indigo, clay, 
gypsum, chalk, curcuma, carbonate of copper, or ace- 
tate of copper ; or black teas to which a "bloom" is 
given by black lead ; or teas with the leaves of which 
are mixed leaves of sloe, oak, beech, willow, plane, 
poplar, chestnut, or hawthorn — his cargo should be 
condemned and destroyed in the first instance, and 



MAXIMS OF PUBLIC HEALTH. 99 

after that, for a new offense, lie should be treated as a 
swindler or poisoner. The Chinese will stop adulter- 
ating teas as soon as cargoes of the stuff are con- 
demned and thrown into the sea. Brewers will con- 
fine themselves to barley-malt and hop-extracts when 
two or three of their number are sent to the peni- 
tentiary for using dangerous drugs to cheapen their 
processes. The public seems to lack sufficient moral 
health and vigor to beget wholesome indignation 
against the perpetrators of fraud and crime in trade 
and commerce. 

The same principle should be applied to those who 
tint wall-papers with arsenical pigments, or color arti- 
cles of wearing-apparel with poisonous aniline dyes. 



Vaccination, isolation, and disinfection are the 
means upon which sanitarians must rely in combating 
small-pox. The methods of using these preventives 
are of great importance. Not only diligence is re- 
quired, but also accurate knowledge of the natural 
history, thus to speak, of this loathsome malady. Cer- 
tain enumerated facts concerning it may be given to 
facilitate reference : 

1. As a rule, small-pox manifests itself on the 
twelfth day, or thirteen times twenty-four hours, after 
infection. The most obvious subjective symptoms are 
fever, headache, back-ache (spine-ache), and nausea. 
Two days afterward, or thirteen times twenty-four 
hours after taking the disease, eruption appears, at 



100 MAXIMS OF PUBLIC HEALTH. 

first in bright-red pimples, with a hard, shot-like base, 
which in due time develop into vesicles, at first round- 
ed, then depressed or umbilicated, afterward into pus- 
tules, which finally become scabs and fall off, leaving 
pock-marks. The object here is not to describe the 
disease from a medical point of view, but to indicate 
certain landmarks from a sanitary point of view. 

2. The best pathologists regard small-pox as not 
contagious during the first two days of fever, head- 
ache, back-ache, and nausea. This is the precious 
period during which the sanitarian may get in his pre- 
ventive work. The symptoms during the two or three 
days of primary fever and first papular eruption are 
striking enough to put the properly educated and 
wary medical attendant on his guard, and he should 
lose no time in communicating his suspicions to the 
health authority, whose duty it is to protect the pub- 
lic. The victim of the disease may be isolated with- 
out endangering even the members of the same family. 
The patient may be removed to the proper hospital, 
and the household may go on in safety, or members 
of the family may be removed to some other place, 
leaving patient and attendants in possession of the 
house. 

3. The eleven days of incubation afford a precious 
period for the observation of those who have been ex- 
posed, and to make preparations for their care, if 
they should be overtaken by the malady. During 
that period they are perfectly safe to others, and may 
be allowed to come and go at their will. As the time 
of probation draws near its close, they should report 



MAXIMS OF PUBLIC HEALTH. 101 

to the health-officer, or be visited by him, for the pur- 
pose of observing the first symptoms of the disease. 
Such suspects should be treated with the greatest 
kindness and sympathy, while strict obedience must 
be required of them for the good of others. I have 
had no trouble in dealing with such, and have made 
them feel that the health authority, while necessarily 
inflexible, is their best and most helpful friend. Cases 
of noble self-sacrifice have been met with, worthy of 
enduring record. A wrestle with loathsome pesti- 
lence, during which the light of life may be extin- 
guished, and the final resting-place be reached in the 
solitude of night, without the presence of mourning 
friends, is not pleasant to contemplate, and can be 
fully appreciated only by those who have looked the 
situation in the face. 

4. Vaccination, always an armed friend against the 
dangerous foe, is especially precious in the hour of 
exposure. "Well performed, with reliable virus, it will 
overtake small-pox and at least modify it into vario- 
loid, when resorted to within three days after infec- 
tion. It is the sling of David with which the giant 
may be slain. The arguments in favor of vaccination 
can not be too often repeated. 

In comparison with the long ages of man's life on 
this planet, vaccination is a new thing. Less than a 
century ago Jenner published his discovery to the 
world. Not a hundred years have elapsed, yet the 
most dreaded of diseases to which man is subject has 
already lost the greater part of its terrors. Against 
the inertia of indolence and apathy, against igno- 



102 MAXIMS OF PUBLIC HEALTH. 

ranee and superstition, against dullness and prejudice, 
against heavy conservatism and unreasoning tradition, 
the practice of vaccination has spread in a few decades 
over the whole civilized world, to the vast benefit of 
mankind. 

A few salient facts and groups of facts will demon-: 
strate to any rational human being the immeasurable 
utility of vaccination : 

(a. ) The great mass of people in all enlightened 
nations have come to believe in it, from observation 
and experience. Vox populi, vox Dei. Enlightened 
public opinion is a very good although not infallible 
criterion of truth. 

(b.) Educated medical men are almost unanimous 
in favor of vaccination. John Simon addressed a 
question, "purposely construed to elicit the expres- 
sion of every existing doubt on the protective influ- 
ence of vaccination," to five hundred and forty-two 
distinguished medical men, British and foreign, and 
received an affirmative answer from all but two of 
them, The British Epidemiological Society published 
a report of its small-pox and vaccination committee 
in 1853, wherein reference is made to favorable an- 
swers from more than two thousand British medical 
men, besides many in other countries. In America 
to-day, as well as in other countries, the physicians 
who do not favor vaccination are exceptions to the 
general rule. 

(c.) The governments of nearly all civilized nations 
favor vaccination, and some of them make it compul- 
sory. The British and German Governments, both of 



MAXIMS OF PUBLIC HEALTH. 103 

them conservative and enlightened, require it. The 
Legislature of nearly every State in this Union has 
enacted a law favoring it. 

(d. ) Statistics on a large scale demonstrate the utili- 
ty of vaccination. In Moravia, Bohemia, and Aus- 
trian Silesia, vaccination reduced the annual mortality 
of 4,000 in every million of population, by small-pox, 
to 200. In Westphalia, where the death-rate from 
small-pox was formerly 2,643 in the million of popu- 
lation, the annual mortality from the same cause de- 
clined to an average of 114 in the million from 1816 
to 1850, under the influence of general vaccination. 
From 1810 to 1850 the yearly death-rate from small- 
pox in Sweden was 158 per million of population, but 
was 2,050 before vaccination. In Berlin the reduc- 
tion was from 3,422 to 176 ; in Copenhagen, from 
4,000 to 200. At the close of the last century the 
estimated rate in England was 3,000. The average 
rate of 1841-'53 was 304. The average rate of 1854- 
'63, embracing two severe epidemics, was 171 per 
million of population. Yet there are men, apparently 
rational, who denounce vaccination, without suspect- 
ing that they are making themselves public male- 
factors. 

(e.) Special statistics demonstrate the benefits of 
vaccination not less strikingly than general statistics. 
Dr. Seaton and Dr. Buchanan, both of them skilled 
observers, examined, in various London schools and 
work-houses, during the epidemic of small-pox in 1863, 
over 50,000 children. A large majority of them had 
been vaccinated in various ways and degrees. Three 



104 MAXIMS OF PUBLIC HEALTH. 

hundred and sixty out of every thousand who had not 
been vaccinated were scarred with small-pox. Less 
than two in 1,000 of those who showed evidence of 
vaccination had small-pox marks. Only one in over 
1,600 who had perfect vaccine marks showed pitting 
from small-pox. Mr. Marson observed and carefully 
recorded 30,000 cases of small-pox under his personal 
care in the London Small-pox Hospital. Deaths among 
the unvaccinated were 3? per cent ; among the vacci- 
nated, 6^- per cent. 

The general drift of statistics on the subject, col- 
lected during the current century, is in the same 
direction. I have no doubt that an epidemic of small- 
pox in the United States, without the protection 
afforded by vaccination, would be quite as calamitous 
as the great war of the rebellion. Were the protec- 
tion as perfect as it might be, we should scarcely know 
of the existence of small-pox. 

Efficient vaccination — that is, vaccination with 
pure virus and properly performed — is, in my judg- 
ment, just as complete protection against small-pox 
as an attack of the disease in the natural way. " Duly 
and efficiently performed," said Jenner, "it will pro- 
tect the constitution from subsequent attacks of small- 
pox as much as the disease itself will. I never ex- 
pected it would do more ; and it will not, I believe, 
do less." Nature does her work perfectly. The ele- 
ment of art enters into vaccination, and the degree of 
its success depends upon the material used and the 
skill of the operator. The best vaccinator can not 
produce good results with imperfect matter. The best 



MAXIMS OF PUBLIC HEALTH. 105 

virus may fail in the hands of a bungler. If such 
grand results in favor of vaccination, as already pre- 
sented, are attained by work that is imperfect, what 
might we not expect with the science, skill, and pains 
which are surely within human reach ? Failure of 
vaccination may involve consequences more dangerous 
to the individual than the amputation of an arm. 
Yet we seek a careful and skilled surgeon to perform 
the latter operation, while any blunderhead is sup- 
posed to be capable of performing the former. The 
surgeon is contented with only the best instruments 
and dressings when he undertakes a capital amputa- 
tion. Yet, when he undertakes to protect a fellow- 
being against a disease which, taken in its natural 
form, kills four out of ten of all who have it, he 
sometimes uses any kind of knife, and exercises less 
care in the selection of virus than he would in the 
choice of a sleeve-button. As pointed out in one of 
the reports of the medical officer of the British Privy 
Council, the degree of protection afforded by vacci- 
nation varies as one to thirty. And the worst of it is 
that slovenly vaccination, with imperfect or worthless 
virus, brings the great and beneficent discovery of 
Jenner into disrepute. 



Going the other day from Albany to New York, I 
discovered a prolific source of enteroid fever. There 
are miles of ice-houses not far below the former city. 
The river at that point is polluted with the sewage of 
Albany, Troy, and other considerable towns. It was 



106 MAXIMS OF PUBLIC HEALTH. 

a just conclusion of the Rivers' Pollution Commission 
of the British Parliament that there is not a river in 
the kingdom long enough to purify water contami- 
nated by sewage. Everybody will admit that the 
water of the Hudson a dozen miles below Albany is 
not pure ; but many deluded people, and some inter- 
ested people who are not deluded, will claim that ice 
is free from the impurities of the water on which it 
is frozen. Such a claim is a delusion and a snare. 
Typhoid fever has been traced to impure ice. 

As in our climate, during the hot months of sum- 
mer, it requires about the same weight of ice as water 
to make the latter palatable to drink, it is necessary 
to exercise equal care about the purity of both. It 
not unfrequently happens that an outcry is made 
about the impurity of drinking-water, when in reality 
the fault is in the ice mixed with it. Ice is supplied 
to families in cities cut on rivers below the discharge 
of sewers where no mortal would think of drinking 
the water. Ponds in suburbs, the water of which is 
repulsive even to look at, furnish crystal ice, which 
people, otherwise prudent and careful, put in their 
refrigerators, and use in contact with fish, poultry, 
fruit, and other delicate food. The essential poisons 
of sewage are mingled with lemonade and other cool- 
ing drinks, by means of the ice used abundantly in 
their preparation. The spores of microscopic plants, 
of deleterious cryptogams, living in putrescent stag- 
nant water, maybe "imprisoned in thick-ribbed ice," 
and conveyed to the stomach in a draught that re- 
freshes on a hot summer day. 



MAXIMS OF PUBLIC HEALTH. 107 

At Eye Beach, in New Hampshire, an attractive 
summer resort, there was mysterious sickness in one 
of the large hotels in the summer of 1875. "A dis- 
turbance of the digestive system, characterized by a 
sensation of giddiness and nausea, vomiting, diarrhoea, 
severe abdominal pains — all of which was accompanied 
by fever, loss of appetite, continued indigestion, and 
mental depression," was a professional description of 
the sickness prevalent in that particular hotel. At 
length it was discovered that the "crystal" ice used 
was cut from a stagnant pond in the vicinity, the wa- 
ter of which smelled very bad in summer. There was 
no bad smell in the ice. It was clear in color, and 
only chemical examination compelled belief in its im- 
purity. The result of the analysis, expressed as usual 
in 100,000 parts, was as follows : 

Ammonia 0-0208 

Albuminoid ammonia 0-0704 

Inorganic matter 7-80 

Organic and volatile matter 5 , '72 

Total solids at 212° Fahr 13-52 

Chlorine (when filtered) 3-23 

A specimen of pure ice, analyzed at the same time, 
gave 0'76 of total solids and 0*02 of chlorine. 

Of course, the ice was not as bad as the water from 
which it was cut, yet it was bad enough to sicken and 
endanger many people in the midst of otherwise 
healthful circumstances.* 

* For a fuller account of impurities in ice, see a paper by A. H. 
Nichols, M. D., in the " Seventh Report of the Massachusetts State 
Board of Health," 18*76, p. 465. His conclusions were verified by 



108 MAXIMS OF PUBLIC HEALTH. 

Extensive and careful experiments have been made 
in the laboratory of Michigan University, under the 
competent supervision of Professor Vaughan, on the 
purification of both crystalloids and colloids by freez- 
ing, from which the conclusion is reached that "pure 
ice can only come from pure water." It is not neces- 
sary to multiply proofs. It is very certain that the 
ice-supply of a city needs sanitary supervision. The 
one essential rule is that ice should not be gathered 
for household use, for use in connection with foods 
and drinks, from water that would not be used for 
the same purpose. " Safety demands," says Professor 
William E. Nichols, a very high authority, "that it 
should not be cut for domestic use on ponds or streams 
which are so polluted as to be rejected for water- 
supply." 

LXIV. 

During the winter of 1881-82, when small-pox 
was epidemic, I allowed fourteen well persons to go to 
the pest-house in the city of Detroit, who wished to 
take charge of other members of their families re- 
moved there on account of the disease. All of them 
were vaccinated or revaccinated at the time of going. 
Not one of them had even a light attack of varioloid. 
When the anti- vaccinationists will show half, or even 
quarter, the number of unvaccinated persons exposed 

Professor S. P. Sharpies, Professor E. S. Wood, and Professor W. B. 
Hills, in 18*79. (See the " Tenth Massachusetts State Board of Health 
Report," 18*79, pp. 119, 120.) 



MAXIMS OF PUBLIC HEALTH. 109 

in the midst of the sick and the dying to concen- 
trated contagion without the least injury, I will then 
listen patiently to their arguments. Dr. Henry Tom- 
kins, Medical Superintendent of the Fever Hospital 
belonging to the Manchester Royal Infirmary at Mon- 
sall, in a paper recently read at Owens College, said : 
"The most striking of all evidence is, perhaps, 
that derived from the small-pox hospitals themselves. 
Here the protective influence of vaccination is seen 
and proved in a manner beyond all cavil. At High- 
gate, during an experience of forty years, no nurse or 
servant having been re vaccinated has ever contracted 
disease, and evidence of the same character I can my- 
self bring forward ; for during the whole time that I 
have had charge of the fever hospital more than a 
thousand cases of small-pox have passed under my 
care, yet no servant, nurse, porter, or other person 
engaged there, has, after revaccination, ever taken it, 
though exposed daily to infection in its most concen- 
trated form. . . . Again, among all the students who, 
during the past two years, have attended the hospital 
for clinical instruction, not one has suffered, all hav- 
ing been revaccinated before being permitted to enter 
the small-pox wards. ... I defy the most enthusi- 
astic or conscientious of anti-vaccinators to produce 
evidence like this on his side of the question, or to 
bring forward even half a dozen persons, choose them 
whence he may, who have not been protected against 
small-pox, and expose them as the students are ex- 
posed, without more or less of the number taking the 
disease. Facts such as these should convert the most 



HO MAXIMS OF PUBLIC HEALTH. 

ardent anti-vaccinator from his folly, and convince 
him that a weapon of defense so powerful as vaccina- 
tion should not be left to the pleasure of the indi- 
vidual, but that the State has the right and duty to 
look after its most thorough performance." 

In view of such facts, it may be unhesitatingly 
concluded that the sanitary authority has the right, 
and duty requires it, to remove to the pest-house a 
homeless person who is reasonably suspected of having 
small-pox. If the precaution is taken to properly 
vaccinate him, he is almost certainly safe. The pub- 
lic is entitled to the benefit of the doubt, especially 
when the danger to the public is a million times 
greater than the danger to the suspected individual. 
I have known small-pox to be disseminated through 
a city, simply by diagnosing a case of varioloid as 
chicken-pox. Solus populi est lex suprema. 



India is the home of cholera. There are accounts 
of earlier epidemics, but our authentic history of 
cholera dates from 1817. In that year it broke out in 
the city of Jessora, northeast of Calcutta, and spread 
over all British India. The mortality is given as 
600,000. In 1818 it spread over all Bengal, to ISTepaul, 
along the whole coast of Coromandel, and to Suma- 
tra. Of General Hastings's army of 18,000 men, 9,000 
died in a short time. In 1819 it first traversed the 
sea, and broke out in Ceylon, Isle of France, and Isle 
of Bourbon. This third wave of cholera was not so 



MAXIMS OF PUBLIC HEALTH. m 

severe in India as the first two, bnt extended farther 
— 40° in latitude, 50° in longitude. In 1820 it was 
more severe all round, and extended to the Philip- 
pines and to China. In 1821 the wave was still more 
destructive, extending eastward to Borneo and Java, 
westward to Persia — through 43° of latitude and 70° 
of longitude. In 1822 the wave rolled on toward 
Europe, into Mesopotamia and Syria. In 1823 it 
swept up through the Chinese Empire, northwestward 
to the coast of the Mediterranean, along the shores of 
the Caspian to Orenburg, in Kussia, on the extreme 
confines of Europe. It was already 4,500 miles away 
from its starting-point in Jessora. A lull of three 
years followed, without further extension. In 1827 it 
broke out with renewed intensity in India, and spread 
to the Himalayas and the Sea of Aral. In the next 
two years, 1828-'29, it was less savage, and extended 
little. In 1830 a higher wave swept over the Cauca- 
sian Mountains, around the Caspian and Black Seas, 
up the Volga, the Don, and the Dnieper, to many cities 
of Russia. In the spring of 1831 a new wave started 
from India, swept westward through Medina and 
Mecca, traveled with pilgrims to Egypt, killed 30,000 
in Cairo, ascended the Nile, reached Smyrna and Con- 
stantinople, ascended the Danube to Vienna, went to 
the extreme north of Russia, traversed Poland to all 
Northern Germany, spared the region of the Rhine, 
barely touched Scandinavia and the coast of England. 
In 1832 it swept over Great Britain and Ireland, 
crossed the Channel to France, killed one forty-third 
of the people of Paris, traversed the Atlantic Ocean, 



112 MAXIMS OF PUBLIC HEALTH. 

murderously attacked Quebec, Montreal, New York, 
Philadelphia, Baltimore, and other cities, and de- 
scended the rivers to New Orleans. In 1833 it deso- 
lated Mexico, and swept over all the rest of the North 
American Continent. In 1834 it ebbed back to Portu- 
gal and Spain, and desolated the northern coast of the 
Mediterranean as far as the Adriatic. The next year, 
1835, it. crossed to Northern Africa and attacked the 
whole Barbary coast, and killed one-fortieth of the 
inhabitants of Malta. In the following years, 1836- 
'37, it eddied around Central Europe, in Germany, the 
Tyrol, Bavaria, and Italy. After this fierce and far- 
spreading epidemic of twenty years, there was a brief 
lull, but not entire cessation, of cholera. 

At the beginning of 1840 a fresh wave started 
from the Ganges, more rapid, more destructive in 
its flow than the first. It is not necessary to fol- 
low it with chronological minuteness. In 1845 we 
see cholera ascending the Tigris and Euphrates, 
from Bagdad through Persia and the adjacent coun- 
tries. In 1846 it again crossed Arabia, slaughtering 
multitudes of pilgrims at Mecca. In 1847 it at- 
tacked Constantinople savagely, from which, as a 
center, it radiated in all directions, especially through 
Eastern Europe. In 1848 it again visited Germany, 
this time murderously, and crossed over the ocean to 
New Orleans, in this country, whence it spread the 
following year. In 1849 its ravages were so severe at 
Paris and in all France as to fill the whole country 
with terror. In this year it prevailed almost every- 
where on both sides of the ocean. 



MAXIMS OF PUBLIC HEALTH. 113 

This epidemic was followed by another, almost 
without interruption. In 1851 and 1852 it devastated 
a large region of Western Asia, especially Persia. In 
1852 Russia suffered severely. In 1852 and 1853 Po- 
land and Northern Germany were sorely revisited. 
The Scandinavian nations were then very fiercely at- 
tacked. In 1853 and 1854 Great Britain, France, and 
the United States were again bitterly punished. In 
1854 and 1855 the pestilence prevailed in all the 
countries bordering the Mediterranean on the north. 
Switzerland, which had escaped the previous epidemic, 
then suffered severely. In 1855 South America was 
first visited. Many have not forgotten how it added 
terror at this time to the Crimean War. 

In 1860, 1861, and 1862 cholera again prevailed 
fearfully throughout India. In 1864 and 1865 it jour- 
neyed westward, crossed Arabia, entered Egypt with 
pilgrims from Mecca, whence it spread over Europe 
and America. In 1866 more soldiers perished by chol- 
era during the Austro-Prussian War than fell on the 
fields of battle. 

The facts for this brief outline I have taken mostly 
from the published writings of Professor H. Lebert, 
who did heroic service at Berlin, Paris, Zurich, or 
Breslau, in every epidemic of cholera with which Eu- 
rope has been visited. He has made a profound study 
of the history of this terrible disease. 

From these facts, and some facts not here given, a 
few important conclusions may be drawn : 

1. No law of periodicity in the recurrence of 
cholera epidemics can be made out. During half a 



114 MAXIMS OF PUBLIC HEALTH. 

dozen decades, wave succeeded wave with only brief 
and irregular intervals. 

2. Cholera has advanced in the lines of human 
travel, literally following the ebbing and flowing tides 
of men. 

3. Cholera moves faster or slower, according to the 
pace of those whom it afflicts. 

4. Its course is checked — only checked, not arrest- 
ed — by cold weather. It has prevailed in England, 
even in frozen Russia, during the winter. 

5. Elevation has an uncertain effect on cholera. 
It has prevailed on the slopes of the Himalayas, has 
overleaped the lofty barriers of the Caucasian Mount- 
ains, and has decimated cities in Mexico of greater 
altitude than the passes of the Alps. 

Dr. C. Macnamara, who has had abundant experi- 
ence of cholera in India, gives a graphic and accurate 
description of an attack of the disease in an able arti- 
cle on the subject in Quain's excellent '''Dictionary of 
Medicine," recently published, from which I extract 
sufficient for my present purpose, condensing and 
freely translating all technical terms into plain Eng- 
lish : 

Asiatic cholera is most deadly at the commence- 
ment of an epidemic, and then usually begins without 
premonitory symptoms. The patient feels well up to 
within a few hours of the attack. As a rule, cholera 
commences with diarrhoea, the stools being copious 
and watery, followed by great prostration, with a pe- 
culiar feeling of exhaustion at the pit of the stomach ; 
the sick person suffers from nausea, but seldom from 



MAXIMS OF PUBLIC HEALTH. 115 

actual vomiting or pain at the outset of the attack. 
If judiciously treated, many patients recover from 
this, the first stage of cholera ; but, if neglected, the 
tendency of the disease is to grow rapidly worse. The 
stools become more frequent, and resemble the water 
in which rice has been boiled ; these liquid evacua- 
tions flow away with a sense of relief, but the patient 
now commences to vomit ; the fluid is ejected from 
his mouth with considerable force, and this adds to 
the increasing prostration, which is one of the most 
urgent and marked features of the disease. The pa- 
tient complains of intense thirst, and burning heat at 
the pit of the stomach : he suffers also excruciating 
pain from cramps in the muscles of the extremities ; 
he is terribly restless ; and his urgent cry is for water, 
and some one to rub his limbs. Although the tem- 
perature of the sick person falls below the normal, 
he complains of feeling hot. The pulse is rapid and 
weak, the breathing hurried, the voice husky, the 
countenance pinched, the skin doughy. The dura- 
tion of this, the second stage of cholera, is very un- 
certain ; it may last two or three hours, or twelve or 
fifteen ; but so long as the pulse can be felt, there is 
hope. The weaker the pulse the nearer the patient is 
to the third or collapse stage, from which few recover. 
The chances depend upon the strength of the heart 
to some extent. In the third stage the vomiting and 
purging continue, but in a mitigated form ; the pa- 
tient can not speak above a whisper, the breathing is 
rapid, the eyes are deeply sunken, and the features 
marvelously changed ; the temperature of the body 



116 MAXIMS OF PUBLIC HEALTH. 

calls, the patient is restless, and longs only for sleep 
and water ; his intellect is clear, bnt he seldom ex- 
presses any anxiety regarding worldly affairs, al- 
though fully conscious of the dangerous condition he 
is in. 

All cases are not so severe. During an epidemic 
many have the cholera lightly, and are the more dan- 
gerous to the public from the fact that they are able 
to go about during convalescence. Some die within 
a few hours after the beginning of an attack. Of 
course, there are all degrees of intensity between the 
two extremes. Epidemics vary in violence. In some 
epidemics half the attacked die ; in others, not more 
than one fifth. 

LXVI. 

It is extremely difficult to give a clear idea of the 
cause of cholera, or of many other epidemic diseases, 
to non-scientific readers. I can only hope to convey 
a somewhat vague and general notion of it, yet suffi- 
cient to make the way in which the disease is spread 
understood. 

All around us, in air, earth, and water, are living 
things, vegetable and animal, too small to be seen by 
the unaided eye. They are invisible, in the ordinary 
sense of the word. The microscope has revealed much, 
but there is unquestionably an immeasurable realm of 
the "infinitely small" which no instruments can 
make known to us ; yet the mind and the imagination 
can penetrate beyond the region of the senses. The 



MAXIMS OF PUBLIC HEALTH. 117 

unseen plants and animals live and die, as the visible 
plants and animals live and die ; only, their propaga- 
tion, growth, maturity, and decay are rapid in pro- 
portion to their minuteness. In the little, as in the 
great, nothing grows but from seed. Where the seed 
comes from in the beginning no man knoweth. Each 
produces after its own kind. In the little, as in the 
great, animals live upon plants or upon one another ; 
and plants live upon the decaying remains of animals 
or upon the rotting debris of other plants. Everywhere 
life and death are strangely intermingled. With every 
breath we draw we take into the lungs myriads of in- 
visible animals and plants. Every swallow of water 
contains an ocean of living things, both from the ani- 
mal and the vegetable kingdom. For the most part, 
these things are harmless, or we should all speedily 
die. Sometimes poisonous invisible plants or animals 
come and cause disease, each after its kind. 

In our own times many diseases, before inexplica- 
ble, have been distinctly traced to their living causes. 
Within this century the common itch has been found 
to be the result of an insect, barely visible to a sharp 
eye, looking very like a mud-turtle under a magnify- 
ing-glass, which creeps from person to person and 
flourishes best in the midst of filth and negligence. 
Within the memory of the living the deadly little 
trichina-worm has been discovered with the aid of the 
microscope ; its wonderful life-habits have been traced ; 
eighty thousand of them have been counted by a pa- 
tient German scientist in a single cubic inch of flesh. 
The minute plant causing the deadly splenic fever, 



118 MAXIMS OF PUBLIC HEALTH. 

killing great numbers of domestic animals, as well as 
human beings, has been discovered quite recently, and 
the laws of its growth have been fully ascertained. 
M. Pasteur has studied all its habits, and Professor 
Tyndall has ascertained what degrees of heat will kill 
both the plant and its seeds. By the aid of powerful 
microscopes the minute plant that gets into the body 
of man and causes malarial fever has been discovered, 
and successful experiments have been made with it 
on the lower animals. The bacterium causing diph- 
theria, a low animal organism, so minute as to be on 
the very borders of the visible, has been recently stud- 
ied out by very skilled microscopists both in Ger- 
many and in this country. Within a year or two 
Koch has startled the world by discovering and de- 
scribing the minute organism that feeds upon the 
lungs of man and causes consumption. 

But enough in the way of preliminary illustration. 
Professor Lebert, a very high authority, expresses the 
convictions of scientific Germany, in regard to the 
cause of cholera, as follows : "A cholera-germ must 
be accepted — in fact, it is now almost universally 
accepted — as the very probable cause of the disease. 
It is easy to understand that a minute, specific, and 
peculiar Indian parasite might develop its action 
wherever it is carried, when it finds favorable condi- 
tions for prolific reproduction." He thinks this mi- 
nute vegetable parasite belongs to the protomycetes — 
the smallest microscopic single-celled plants. This 
minute parasite, originating only in India, flourishes 
in the stomach and intestines of man, when planted 



MAXIMS OF PUBLIC HEALTH. 119 

there, and causes cholera. The poison, whether vege- 
table or animal, or something else, is contained in the 
discharges from the bowels of cholera-patients. Dr. 
Macnamara says : " Cholera-patients can not, in fact ? 
communicate the affection to others, unless by the 
means of the discharges which they pass. Persons at- 
tending them run no risk of contracting the disease, pro- 
vided they are protected from swallowing the organic 
poison passed by the sick ; but, in badly ventilated 
rooms, this organic matter, having been disseminated 
in considerable quantities through the atmosphere, 
may be taken into the system by attendants, and so 
poison them." Dr. W. Aitken observes that the evi- 
dence in favor of the communicability of cholera by 
means of water or food contaminated with cholera- 
dejecta has, since 1854, become almost overwhelming. 
A volume from great authorities on this point might 
be cited. 

The ways in which food and drink may become 
contaminated with the excreta of cholera-patients are 
numerous, and obvious enough to skilled investiga- 
tors. The subject is far from being inviting, but it 
lies at the very core of any fruitful consideration of 
the diffusion of cholera. Correlatively the means of 
preventing the disease must be sought in the study 
of the problem how to escape planting its minute and 
disgusting germs in the stomach and bowels. 

Let us go in imagination to the sick-room and 
closely observe the scene. The attendants on the 
patients are bewildered, perhaps terrified, by a sud- 
den and dangerous and it may be fatal calamity. 



120 MAXIMS OF PUBLIC HEALTH. 

They forget, quite likely don't know, that the copi- 
ous rice-water excreta contain the seeds of cholera, 
so much to be dreaded. The patient is probably 
helpless. Bed-clothing and personal clothing are 
diffusively soiled. The hands of attendants are in- 
fected. Bread is broken and eaten with half-washed 
fingers. Eemember, it takes but a microscopic parti- 
cle to inoculate a susceptible person. Drinking-cups 
are handled, and the edges smeared, with dirty fin- 
gers — perhaps not visibly dirty, but we are consider- 
ing a poison that can not be seen with the naked eye. 
The soiled clothing is piled in a dark closet, where 
the deadly germs are still further multiplied in the 
stagnant air and in the recesses of the infected 
fabrics. When the door is opened, the germ-laden 
air comes in contact with lips and throat, and the 
invisible poison is swallowed, to germinate in a 
deadly harvest through the stomach and intestines. 
Sometimes the atmosphere of the sick-chamber be- 
comes so close and foul for the want of ventilation as 
to produce the same results on the inmates. The 
dirty linen is especially dangerous to those who wash 
it. Invisible spores, or germs, of the cholera-fungus 
rise to the face of the laundress. Pocket-handker- 
chiefs and towels become easily soiled in the sick-room 
and are unconsciously or forgetfully placed in contact 
with the lips. The contents of chamber- vessels used 
by patients are not unfrequently thrown out upon 
the ground, or into vaults, where, under favoring 
conditions, the germs are multiplied and may find 
their way through the veins of the earth into wells of 



MAXIMS OF PUBLIC HEALTH. 121 

drinking-water, tens of feet, perhaps hundreds of 
feet away, thence to be conveyed to the stomachs and 
intestines of many unsuspecting people. 

Drinking-water, polluted in some such way, is the 
most fertile source of cholera. In India,, foul pil- 
grims defecate, bathe, wash their clothes in and 
drink from the same pool. In many Christian cities, 
sewage empties into the same stream from which 
the water-supply is taken. All over our own en- 
lightened land we find the privy and the well in dan- 
gerous proximity. The milkman perhaps washes his 
utensils, or even dilutes his milk, with infected 
water, and distributes the death-laden liquid to whole 
neighborhoods. The excreta thrown upon the ground 
perhaps dry up, and the germs are blown to the lips 
of people in the distance. 

There is abundant, perhaps even demonstrative, 
objective evidence of the preponderating influence of 
polluted drinking-water in the dissemination of chol- 
era. " In 1854," says Dr. Parkes, " occurred the cele- 
brated instance of the Broad Street pump in Lon- 
don, which was investigated by a committee, whose 
report, drawn up by John Marshall, of University 
College, with great logical power, contains the most 
convincing evidence that, in that instance, at any 
rate, the poison of cholera found its way into the 
body through the drinking-water." In Scotland, Dr. 
Stevenson Macadam has published very striking co- 
incidences between the abatement of the disease and 
the introduction of a fresh and pure supply of water. 

In the city of Rotterdam, during an epidemic of chol- 
6 



122 , MAXIMS OF PUBLIC HEALTH. 

era, the introduction of pure water immediately re- 
duced the mortality to one half. Dr. Aucland re- 
lates, as quoted by Dr. Parkes, that two jails were 
near each other : the one suffered, the other did not ; 
the water was impure in one case from drainage, pure 
in the other. The jail with bad water having got a 
fresh supply, the cholera did not appear in the next 
epidemic. In Haarlem, Holland, cholera prevailed 
with great intensity in 1849. In 1866 it returned, 
and again prevailed as severely in all parts of the 
town, except one. The part entirely exempted in the 
second epidemic was inhabited by bleachers, who, be- 
tween 1849 and 1866, had obtained a fresh source of 
pure water. Professor Foerster has shown that five 
towns of Silesia (of five thousand to twelve thousand 
inhabitants) are entirely free from cholera, which 
never spreads, even when introduced. The only com- 
mon condition is a water-supply from a distance 
which can not be contaminated. In Glogau half the 
water is from a distance and half from wells : those 
using the former remain free ; those using the lat- 
ter are attacked. Dantzic and Konigsberg former- 
ly suffered equally : Dantzic, having a new water- 
supply, does not suffer ; Konigsberg, with its origi- 
nal supply, continues to suffer. In Berlin, in 1866, 
cholera prevailed much more in the houses supplied 
with bad water than in houses supplied with good 
water. Even in India the introduction of better 
water, in Calcutta and other cities, has greatly di- 
minished the disease. Dr. Parkes again says that the 
prevalence of cholera in Russia, with a temperature 



MAXIMS OF PUBLIC HEALTH. 123 

below zero, has always seemed extraordinary, and it 
appeared only possible to explain it by supposing that 
in the houses the foul air and the artificial tempera- 
ture must have given the poison its necessary condi- 
tions of development. But Dr. Kouth has pointed 
out that, in the poorer Russian houses, everything 
is thrown out round the dwellings ; then, owing to 
the cold, and the expense of bringing water from a 
distance, the inhabitants take the snow near their 
houses and melt it. It is thus easy to conceive that, 
if cholera excreta are thrown out, they may be again 
taken into the body. This is all the more likely, 
as cholera emanations have little smell or taste, and, 
when mixed even in large quantity with water, are 
indetectable by the senses. 

Great Britain, with her Indian colonies, has had 
unequaled experience of cholera. Eeports of special 
commissions have accumulated an overwhelming mass 
of facts in favor of the views here presented. 



The prevention of cholera is already indicated 
in the explanation of its cause, and in the descrip- 
tion of the ways in which it is diffused. Extreme 
cleanliness on the part of attendants is of the ut- 
most importance. The hands should be thoroughly 
washed as often as soiled, and the water in which 
they are washed should not be left for another to 
use. Towels on which the hands are wiped should 
never be put to the face ; a microscopic particle of 



124 MAXIMS OF PUBLIC HEALTH. 

infection might be planted on the mucous surface of 
the lip. Dishes and drinking-cups used by the pa- 
tients should be used by no one else, and when re- 
moved from the room should be immediately washed 
in boiling water. Any food tasted by the patient 
should be burned without delay. Beware of wiping 
the face with pocket-handkerchiefs and napkins that 
have been held with soiled fingers., The sick-room 
should be well ventilated, so as to prevent multiplica- 
tion of germs in the stagnant air. The body and bed- 
linen of the patient, as soon as soiled, should be put 
in water containing some strong disinfectant. Twelve 
gallons — four pailfuls — of water in a tub, in which 
have been dissolved two pounds of sulphate of zinc 
and three ounces of carbolic acid make a good recep- 
tacle for such a purpose. Let the clothes stand in 
soak for several hours, and then boil and wash them. 
Soiled mattresses that can not be boiled and washed 
should be burned. A pail of water in which have 
been dissolved half a pound of sulphate of zinc and 
an ounce of carbolic acid should be at hand, and some 
of it should be poured into chamber- vessels every 
time they are used. If there is nothing else at hand, 
use strong vinegar for such a purpose. The doctor 
will direct you as to other disinfectants. If the con- 
tents of chamber- vessels should be thrown into a privy- 
vault, or on the ground, without disinfection, make 
haste to cover the same with fresh lime, chloride of 
lime, strong solution of copperas, or some other de- 
stroyer of germs. Carbolic acid, to be effective, must 
be used in pretty large quantities. A solution of cor- 



MAXIMS OF PUBLIC HEALTH. 125 

rosive sublimate is very potent for disinfection, but it 
is a dangerous poison to have about. The same is 
true of nitric, sulphuric, and hydrochloric acids. 

If such exhaustive pains could be taken in the care 
of individual cases, cholera would not spread to any 
great extent. It is the light cases of cholera, how- 
ever, that most disseminate the disease. After a brief 
attack, not dangerous to themselves, patients go about 
while the stools still contain the poisonous germs 
which are not at all cared for, and become very dan- 
gerous to others. So important is this fact, and so 
well is it understood in England, that when some pa- 
tients, with a slight attack, escaped from an infected 
ship at a southern port and journeyed by railroad to 
Liverpool, sanitary officers followed and disinfected 
water-closets at every station where it was possible for 
them to stop, thereby averting the spread of the dis- 
ease. During the prevalence of cholera, all water- 
closets on steamboats and at railroad depots should be 
thoroughly disinfected every day. The germs of the 
disease multiply in the filth of such places, and may 
infect a mucous surface in those who are obliged to 
frequent them. 

As in most places there is no provision of law for 
the inspection of dairies outside of the jurisdiction of 
health-officers, it is very important that the people 
should know how to protect themselves against possi- 
ble contagion from milk. Boiling will kill any germs 
that may find their way into milk from the soiled fin- 
gers of those who handle it, or from infected water 
used to adulterate it, or to wash the cans in which 



126 MAXIMS OF PUBLIC HEALTH. 

it is carried. Cooked cholera, like cooked small-pox, 
is harmless. Boiling milk before it is used would 
doubtless prevent some mysterious cases of diphtheria, 
scarlet fever, and typhoid fever. The boiling of milk 
would probably also save some children who die of 
cholera infantum. 

Drinking-water is of the greatest importance. In 
many towns the water-supply is liable to pollution. 
The only way to escape danger during the prevalence 
of cholera is to boil the water before using it. Boiled 
water is not pleasant to the taste, but a weak infusion 
of tea will make it palatable. Ice will improve it ; 
but look out for ice cut on questionable ponds and 
inlets, or below sewers in a winter following a cholera 
season. The spores, or seeds of the cholera fungus, 
may stand any amount of cold, while a boiling-heat 
speedily kills them. Seed-corn will never germinate 
after boiling, but a cold of forty degrees below zero 
does not hurt it. 

No amount of filth will create cholera, but it fur- 
nishes the conditions for its spread. Want, squalor, 
negligence, unclean habits, will not start it anew, but 
the disease flourishes amid, such surroundings. If a soil 
be ever so rich, it will not grow a crop unless the seed 
is sown. The sowing of seed will not produce a crop 
unless the soil is good. In combating cholera, as in 
combating other epidemic diseases, we must always do 
two things — we must, if possible, prevent the sowing 
of the seed, and must also make the soil unsuited to its 
growth. Cleanliness and the prevention of the diffu- 
sion of the noxious germs are of equal importance. 



MAXIMS OF PUBLIC HEALTH. 127 

All authorities are agreed that it is of vital im- 
portance to promptly attend to the usual preliminary 
diarrhoea during the prevalence of cholera. In Brit- 
ish India it is a standing military order that any sol- 
dier going more than once a day to the latrine shall 
immediately report to the medical headquarters. Then 
is the precious time for treatment. If cholera is 
about, every one should go to his physician and pro- 
cure a medicine for this premonitory condition, al- 
ways to be carried about with him. 

Beware of quacks and the advertisers of cholera- 
cures ; your trusted family physician is the one to 
consult, and his advice will be safest to follow. Any 
essential changes of diet are more harmful than bene- 
ficial. Unripe or decaying fruits and vegetables should 
be carefully avoided. Temperance in all things is best. 
Drunkards, gluttons, and debauchees are among the 
earliest victims of cholera.* 



LXVIII. 

Scarlet fever, scarlatina, scarlet rash, canker rash, 
rash fever (all different names for the same disease), is 
not especially contagious at the outset of an attack, 
although it becomes so after the first day or two, and, 
therefore, when it is early recognized, opportunity 
is afforded to take precautions against its spread. 
When patients are cared for at home, as they generally 

* For a pretty full account and estimate of Professor Koch's 
recent investigations, see Appendix. 



128 MAXIMS OF PUBLIC HEALTH. 

must be, the following rules, published some time ago 
by the British Society of Medical Officers of Health, 
and followed by careful and intelligent people in Eng- 
land, are excellent, and will save a great deal of suf- 
fering and sorrow if strictly observed : 

"1. Separate the sick person from the rest of the 
family directly illness appears, placing him, if pos- 
sible, in a room at the top of the house, and taking 
care to remove carpets, curtains, and all unnecessary 
articles of furniture and clothing therefrom. 

"2. Admit fresh air by opening the upper sash of 
the window. The fireplace should be kept open, and 
a fire lighted if the weather permits. Fresh air 
should be freely admitted through the whole house 
by means of open windows and doors. The more air 
that passes through the house, the less likely is the 
disease to spread. 

" 3. Hang up a sheet outside the door of the sick- 
room, and keep it wet with a mixture made either 
with a quarter of a pint of carbolic acid, or a pound 
of chloride of lime, and a gallon of water. 

" 4. Everything that passes from the sick person 
should be received into vessels containing half a pint 
of a solution of green copperas, made by dissolving 
one pound of the copperas in a gallon of water. A 
like quantity of the solution of copperas should be 
added to the discharges before emptying them into 
the closet. 

" 5. Every sink, closet, or privy should have a 
quantity of one of the above-named disinfectants 
poured into it daily, and the greatest care should be 



MAXIMS OF PUBLIC HEALTH. 129 

taken to prevent the contamination of well or drink- 
ing water by any discharges from the sick person. 

"6. All cups, glasses, spoons, etc., used by the 
sick person should be first washed in the above-named 
solution of carbolic acid, and afterward in hot water, 
before being used by any other person. 

"7. No article of food should be allowed to re- 
main in the sick-room. No food or drink that the 
sick person has tasted, or that has been in the sick- 
room, should be given to any one else. 

" 8. All bed and body linen, as soon as removed 
from the sick person, and before being taken from 
the room, should be first put in a solution of car- 
bolic acid of the above-mentioned strength, remain- 
ing therein for at least an hour, and afterward boiled 
in water. 

" 9. Instead of handkerchiefs, small pieces of rag 
should be used, and these, when soiled, should be im- 
mediately burned. 

" 10. Persons attending on the sick should not 
wear woolen garments, as they are likely to retain in- 
fectious poison ; dresses of cotton, or of some wash- 
able material, should be worn. Nurses should always 
wash their hands immediately after attending to the 
sick person, using carbolic-acid soap instead of ordi- 
nary soap. 

"11. It is of the utmost importance that the sick- 
room be not frequented by others than those in im- 
mediate attendance on the sick, as the clothing of 
visitors is very liable to carry away infection. 

"12. The scales and dusty powder which peel 



130 MAXIMS OF PUBLIC HEALTH. 

from the skin in scarlet fever, and the crusts in small- 
pox, being highly infectious, their escape may be pre- 
vented by smearing the body of the sick person all 
over every day with camphorated oil. This, and the 
after-use of warm baths and carbolic-acid soap, are 
most essential. The sick person must not be allowed 
to mix with the rest of the family until the peeling 
has entirely ceased, and the skin is perfectly smooth ; 
clothes used during the time of illness, or in any way 
exposed to infection, must not be worn again until 
they have been properly disinfected. 

" 13. When the sickness has terminated, the sick- 
room and its contents should be disinfected and 
cleaned. This should be done in the following man- 
ner : Spread out and hang upon lines all articles of 
clothing and bedding ; well close the fireplace, win- 
dows, and all openings ; then take a quarter to half 
a pound of brimstone, broken into small pieces, put 
them into an iron dish, supported over a pail of 
water, and set fire to the brimstone, by putting some 
live coals upon it. Close the door, and stop all crev- 
ices, and allow the room to remain shut up for 
twenty-four hours. The room should then be freely 
ventilated by opening the doors and windows, the 
ceiling should be whitewashed, the paper stripped 
from the walls and burned, and the furniture and all 
wood and painted work be well washed with soap and 
water containing a little chloride of lime. Beds, 
mattresses, and articles which can not well be washed, 
should, if possible, be submitted to the action of heat 
in a disinfecting chamber. Until this process of dis- 



MAXIMS OF PUBLIC HEALTH. 131 

infection is effectually carried out, the room can not 
be safely occupied. 

"14. Children should not be allowed to attend 
school from a house in which there is infectious dis- 
ease, as, although not ill themselves, they are very 
likely to carry the infection, and so spread the disease. 
No child should be allowed to re-enter a school with- 
out a certificate from the medical attendant, stating 
that he can do so without any danger of infecting 
other children. 

" 15. In case of death, the body should not be re- 
moved from the room, except for burial, unless taken 
to a mortuary, nor should any article be taken from 
it until disinfected as before directed in rule No. 13. 
The body should be put into a coffin as soon as pos- 
sible, with a pound or two of carbolic powder. The 
coffin should be fastened down, and the body buried 
without any delay." 

The methods of disinfecting recommended in the 
preceding rules may be varied in accordance with in- 
structions given elsewhere in this book. Scarlet fever 
requires fully as much care and caution as small-pox. 

LXIX. 

The cavities of the face, neck, and head * are con- 
tinuously lined with mucous membrane, which is ex- 
tensive enough, if it were dissected out, to form an 
ample night-cap. On this mucous membrane diph- 

* The mouth, pharynx, larynx, trachea, bronchi, Eustachian 
tubes, inner ears, cells of the mastoid processes of the occipital 



132 MAXIMS OF PUBLIC HEALTH. 

theria manifests itself, as srnall-pox manifests itself 
on the skin. The disease rarely invades all these cavi- 
ties ; its favorite seat is the throat, or fances. Some- 
times it also shows itself on other mucous surfaces, 
even on abraded patches of the skin. 

Diphtheria is a good deal older than its name. 
Hippocrates, Oelsus, Galen, Sydenham, and many 
others, have described it clearly enough, but it was 
reserved for Bretonneau, of Tours, to differentiate it 
and to give to it a distinct title and place in medical 
literature. In 1826 Bretonneau published his "Ke- 
cherches, etc., sur la Diphtherite." In 1855 he pub- 
lished his latest memoir, in which the term diphtherie 
is substituted for diphtherite. In 1859 the Sydenham 
Society of London published a volume on the subject 
of " Diphtheria," translated from the French of Bre- 
tonneau and others. Previous to that, the term was 
unknown in English medical literature. 

Eminent German pathologists and microscopists — 
Oertel, Hueter, von Recklinghausen, Waldeger, Klebs, 
Eberth, Heiberg, Virchow, Massiloff, Trendelenberg, 
Tommassi-Crudeli, Cohn, and others — have for some 
years regarded the disease as the result of a living 
organism, a bacterium termo. On the other hand, 
many British histologists question the conclusions of 
their German brethren. Whether the bacterium is 
the cause, product, or concomitant of diphtheria, 
does not seem to be settled.* 

bone, nares, lachrymal ducts, antrum of Highmore and the passages 
leading thereto, conjunctiva, and frontal sinus. 

* Wood and Formad, in this country, competent observers, in- 



MAXIMS OF PUBLIC HEALTH. 133 

Several thousand cases of diphtheria have come un- 
der my sanitary supervision in the administration of 
municipal regulations for the control of infectious dis- 
eases, affording me abundant opportunity for investi- 
gating it, not pathologically, not therapeutically, but 
in its hygienic relations. My official sanitary service 
has been in two large cities, the laws of which require 
physicians and householders to report to the health 
department all cases of contagious diseases. By the 
aid of competent inspectors I have investigated the 
sanitary condition of every house in which diphthe- 
ria has been reported, with especial reference to site, 
plumbing, drainage, connection with sewers, etc. My 

vestigated diphtheria under the direction of the National Board of 
Health, and came to the following general conclusions : 

" 1. The micrococci of diphtheria do not differ, so far as observed, 
from those of furred tongue, etc., except in their tendency to growth 
in culture-fluids. 

"2. The micrococci of furred tongue, or ordinary sore throat, 
have a less tendency to grow under culture than have the micrococci 
of endemic, non-malignant diphtheria. 

" 3. The micrococci of endemic or non-malignant diphtheria have 
a much less tendency to grow under culture than have the micro- 
cocci of malignant diphtheria. 

" 4. The rapidity of growth of the micrococci is in direct propor- 
tion to the malignancy of the case yielding them, and its contagious- 
ness. 

" 5. On exposure to the air, diphtheritic membrane of the most 
virulent type loses its contagious power, and the micrococci pari 
passu lose their power of growing in culture-fluids. 

" 6. Under successive generations of artificial culture, the diph- 
theritic micrococci lose their growth and activity, and also their 
power of infecting the rabbit. 

" 1. It has not been experimentally directly proved, but it ia a 



134 MAXIMS OF PUBLIC HEALTH. 

large experience has given me a very strong convic- 
tion of the following facts : 

1. The gaseous emanations of filth, of organic 
matter in process of putrefaction, is the very breath 
of life to diphtheria. It loves broken drains, un- 
trapped waste-pipes, un ventilated soil-pipes, manure- 
heaps, and foul sewers. It delights in a habitation 
built on a site filled in with street-cleanings. Base- 
ments flooded with sewage charm the fiend. The 
smell of rotten vegetables in the cellar it construes 
into an invitation to call and make itself at home. 
Excrement-sodden soil and polluted drinking-water 
make it happy. 

2. Diphtheria is contagious and infectious. Food 
tasted by the sick, the air of an unventilated cham- 
ber, drinking-cups, towels, pocket-handkerchiefs, any- 
thing that will convey the subtile poison from the 
diseased mucous membrane of the patient to the mu- 



necessary inference from the two facts just stated, that under cer- 
tain favoring circumstances the sluggish micrococci take on growth- 
activity, and in all probability poisonous properties. 

" 8. Every grade of case can be found in man, from an ordinary, 
sore throat, through simple pseudo-membranous angina and trachitis, 
up to malignant diphtheria. 

" 9. Any inflammation of the trachea of sufficient intensity may 
cause the formation of a pseudo-membrane. 

"10. A case may begin as one of sthenic ' pseudo-membranous 
croup,' and end as one of adynamic ' diphtheria,' with blood-poison- 
ing ; and in cases of this character not unfrequently no exposure to 
contagion is discoverable, and there is clinically every reason to be- 
lieve that the blood-poison has been developed within the body of 
the patient." 



MAXIMS OF PUBLIC HEALTH. 135 

cous membrane of persons in the vicinity, will com- 
municate the distemper. Many a child is killed with 
a diphtheritic kiss. 

3. As a rule, people will have small-pox, scarlet 
fever, measles, and many other infectious diseases, 
but once. Diphtheria is an outlaw, and repeats itself 
as often as it gets a chance. 

4. Nursing children and old people are not apt to 
have diphtheria, but may have it. Mature women 
take their nurslings with them to see a diphtheria 
patient or corpse, and are ready to swear that the dis- 
ease is not "catching," because neither they nor their 
babies have been infected. 

5. So-called membranous croup, except when trau- 
matic, is identical with diphtheria. Some doctors 
still call diphtheria membranous croup, when it af- 
fects the larynx and trachea, and is not visible in the 
throat. Terrible mischief may be done when the 
wrong name leads to the supposition that the case is 
not contagious. Death frequently steps in to break 
the dangerous obstinacy of practitioners and people 
on this point. 

6. Sore throats are as dangerous as Egyptian sore 
eyes. They may contain a contagious diphtheritic ele- 
ment, especially when diphtheria is epidemic. Some 
physicians tell the people that all cases of real diph- 
theria terminate in death. The inference is that 
cases which get well are not diphtheria at all. Such 
physicians are fools or knaves — fools, if they don't 
know any better ; knaves, if they are attempting to 
disarm precaution for the purpose of increasing trade. 



136 MAXIMS OF PUBLIC HEALTH. 

The mortality of diphtheria averages about forty per 
cent, the same as that of small-pox. 

7. Diphtheria, which is now the most continu- 
ously murderous contagious disease afflicting the civi- 
lized, portions of mankind, can not be eradicated till 
communities and people eliminate filth, or, in other 
words, till all organic wastes are removed from in- 
habited places before the process of putrefaction 
evolves the gases that feed it, perhaps create it. Iso- 
lation and disinfection can materially check its career, 
but can not entirely stop it, while cesspools, vaults, 
polluted drains, foul sewers, and areas of soil con- 
taminated with stagnant water and animal excreta, 
continue to distill their poisons into the air which we 
breathe and into the water which we drink. 

People sometimes ask why, if these things are so, 
diphtheria prevails in the open country not less than 
in cities. It flourishes in the country for the simple 
reason that the drinking-water of the farm-house is 
often furnished by the well into which seeps the 
drainage of a foul vault or rotten barn-yard, and the 
inmates of the farm-house breathe air reeking with 
putrescent slops ponded about the kitchen-door. The 
habitations of the country, as a rule, are in worse 
sanitary condition than those of cities. 

The rules to be observed in the care of scarlet- 
fever patients should also be observed in the care of 
those afflicted with diphtheria. It is not necessary 
to repeat details previously given. 



MAXIMS OF PUBLIC HEALTH. 137 



Typhus fever is much rarer in this country than 
formerly. In crowded and unventilated quarters it 
feeds on air poisoned with the putrefactive exhala- 
tions of the human skin. It is held possible by some 
that it may originate de novo from such a source. It 
is a highly contagious fever, and requires precisely the 
same care as scarlet fever. "Wash it out, if possible, 
by letting into its haunts an ocean of fresh air. 



Genuine enteric or typhoid fever is diffused in 
the same way as cholera, and requires the same care. 
Bilious fever, springing from malaria, and modi- 
fied in type by conditions of filth, is often called ty- 
phoid fever. It is really an enteroid fever. Many 
have called it typho-malarial fever. It is probably 
not infectious, but it is far better to use too much 
rather than too little precaution with it. The con- 
ditions of enteroid fever are always favorable to the 
spread of typhoid or enteric fever, when the seed is 
once sown. It is not certain that real enteric fever 
may not start de novo by drinking water or breathing 
air impregnated with particles of putrefactive excreta. 
Cleanliness is the best means of combating even 
typho-malarial or enteroid fever, which is frequently 
very destructive. 



138 MAXIMS OF PUBLIC HEALTH. 



LXXII. 

The vast literature of yellow fever is in a state of 
great confusion and perplexing contradiction, owing, 
in my judgment, to the confounding of certain icte- 
roid forms of malarial fever with true yellow fever. 
The word fever is unfortunate, here as well as else- 
where, inasmuch as it expresses a morbid condition of 
many diseases, instead of a disease itself. The icte- 
roid forms of malarial fever are climatic, not conta- 
gious, and are influenced by specific treatment. True 
yellow fever is not the product of climate, although 
dependent on climate for the conditions of its growth, 
prevalence, and intensity ; is contagious, and is not 
even modified by any known treatment. 

In a few sentences I will give the conclusions of 
some eminent physicians who have had experience 
with yellow fever, but would suggest that readers do 
not lose sight of the distinction made in the previous 
paragraph. 

Yellow fever is rarely found south of the twen- 
tieth degree of latitude, or north of the fortieth, at 
this end of the globe. It is much more common in the 
Western Hemisphere than in the Eastern. It is more 
common in Europe than in Africa. It is almost al- 
ways confined to commercial seaports and to towns 
on the banks of navigable rivers. In sections of the 
country where it prevails it is usually confined with- 
in circumscribed limits. In the Eastern Hemisphere 
it visits most frequently the Mediterranean ports 
of Spain. In America the seaports of the Gulf of 



MAXIMS OF PUBLIC HEALTH. 139 

Mexico are its favorite seats. It frequents the Atlan- 
tic ports from Charleston southward, yet it has often 
visited ports as far north as New York. New Or- 
leans is a favorite haunt of yellow fever, and it often 
visits Natchez, Vicksburg, Memphis, and other river 
towns on the lower Mississippi. Probably the habitat, 
or native place, of yellow fever is on shipboard. There 
it usually breaks out while the ship is in port. Some- 
times it breaks out in a ship at sea. In 1799 the 
frigate General Greene sailed from Newport, Ehode 
Island, for Havana, and yellow fever broke out be- 
fore she reached port. Dr. La Eoche, who has writ- 
ten the most exhaustive treatise on the subject, shows, 
as I think conclusively, that the origin of yellow fever 
is on shipboard, without the operation of external 
agencies ; but he goes too far in saying, without " the 
introduction of contagious germs." Dr. Wilson, a 
very high authority, says that, at the beginning, the 
disease is confined to a small space on shipboard, 
usually the center, where the bilge- water settles. It 
is a curious thing, often observed, that yellow fever 
is usually confined to certain well-defined quarters or 
neighborhoods in cities where it prevails. Dr. Nott, 
of Mobile, says : " I have on two occasions seen yel- 
low fever commence in a point in a town, and eat 
through it, square by square, like worms in a cotton- 
field, taking each time nearly a month for the pro- 
cess." M. Berthe, one of the French commission to 
investigate the epidemic in Andalusia in 1800, says : 
" It was distinctly observed that the malady seized all 
the houses situated on the same side of the street, and 



140 MAXIMS OF PUBLIC HEALTH. 

rarely passed over to the other side, where streets were 
wide and well aired." 

The disease is almost always most prevalent in 
July and August, but sometimes extends through 
September, October, and even November. In 1793 
a severe epidemic visited Philadelphia, which lasted 
till the middle of October. A great epidemic visited 
New York in 1798, which lasted till the middle of 
November. The deaths were over two thousand. In 
New York, between six and seven hundred died of 
yellow fever in 1803. Three hundred died of it in 
1805. In the same city there were one hundred and 
sixty-six deaths in 1822. It is a curious fact that in 
New York, in 1800, it continued ten days or more 
after the first frost. But, as Dr. Walters says, the 
out-door poison was killed by the frost, but the infec- 
tion remained in the houses. Dr. La Eoche gives an 
analysis of fifteen epidemics in which the mortality 
was greatest in October. In Philadelphia, in 1820, it 
lingered till the last of November. As they say in 
the South, it requires a black frost to kill it. The 
most reliable observers of yellow fever have come to 
the conclusion that its prevalence does not depend 
upon the heat of the season. The New Orleans 
Board of Health say : " The disease has been known 
to prevail here alike in dry or wet seasons, and with- 
out regard to the variations of temperature in the 
summer months." 

There are many curious facts in regard to the dis- 
ease. As a rule, people will not have it twice. Men 
are more susceptible to the disease than women. In 



MAXIMS OF PUBLIC HEALTH. 141 

an epidemic which desolated the Island of Barbadoes, 
for one woman that died there were ten men. In the 
great Spanish epidemic of 1804, the aggregate mor- 
tality in twenty-three towns was 45,322 ; the male 
deaths amounting to 28,852, the female to 17,470. In 
Charleston, South Carolina, from 1817 to 1839, there 
were 976 deaths of males and 178 of females. As a 
rule, negroes have yellow fever much more lightly 
than Caucasians. Yellow fever is more liable to at- 
tack plethoric and stout people than the delicate and 
feeble. Several first-class authorities have observed 
that persons suffering with syphilitic disease are es- 
pecially liable to it . In yellow-fever regions the na- 
tives are much more exempt than the unacclimated. 

Dr. G-reeneville Dowell, in his treatise on yellow 
fever and malarial diseases, expresses the views of 
many when he says : " Yellow fe"ver can not be 
taken, in pure air, from persons, clothing, trunks, or 
black- vomit ; but in an impure air, other things be- 
ing suitable, it can be taken from either." From his 
investigation into the conditions and causes of yellow 
fever in the United States, with the help of the libra- 
ry of the surgeon-general at Washington, and a per- 
sonal experience of over two thousand cases, he con- 
cludes that nothing is so important in the prevention 
of yellow fever as proper water-supply and sewerage. 
More than one tenth of the inhabitants of Buenos 
Ayres died of yellow fever in 1871. As the epidemic 
was traced largely to filth, an English engineer was 
employed to carry out a complete system of sewerage 
and water-supply. A subsequent sanitary report 



142 MAXIMS OF PUBLIC HEALTH. 

emanating from that city says : " The works of drain- 
age and sewerage so actively prosecuted at the present 
time are destined to radically remove this infection, 
which experience has demonstrated to be one of the 
most fruitful causes of disease and death." "While the 
Federal troops were in possession of New Orleans, 
during the late " unpleasantness," the commanding 
general required the city to be cleaned up ; the result 
of which was the banishment of yellow fever for the 
time being. Not that General Butler and the medi- 
cal men on his staff knew more about yellow fever and 
sanitary science than the existing Board of Health of 
New Orleans ; but under martial law, with a great 
army at command, certain things can be easily done 
which municipal governments utterly fail to carry 
into effect. Fools in every community resist, actively 
or passively, the execution of sanitary law, and noth- 
ing less stringent than military despotism can over- 
come the resistance. 

The following conclusions were reached by the 
Yellow Fever Commission in a report presented to the 
American Public Health Association, at Eichmond, 
on the 20th of November, 1878, after investigating 
the sad but instructive epidemic of that season : 

" 1. We have not in a solitary instance found a case 
of yellow fever which we could justifiably consider as 
of de novo origin, indigenous to the locality. 

"2. In respect to most of the various towns which 
we visited and which were points of epidemic preva- 
lence, the testimony showing the importation was di- 
rect and convincing in its character. 



MAXIMS OF PUBLIC HEALTH. 143 

"3. The transmission of yellow fever between 
points separated by any considerable distances ap- 
peared to be wholly due to human intercourse. In 
some instances the poison was carried in clothing, or 
about people going into infected districts. In others 
it was conveyed in cotton bagging, or other goods of 
the same description. 

"4. The weight of testimony is very pronounced 
against further use of disinfectants. Physicians in 
infected towns, almost without exception, state that 
they are useless agents to arrest the spread of yellow 
fever, while some of them affirm that their vapors 
are seriously prejudicial to the sick.* 

" 5. Personal prophylaxis, by means of drugs or 
other therapeutic means, has proved a constant fail- 
ure. A respectable number of physicians think the 
use of small doses of quinine of some use in the pre- 
vention. 

"6. The quarantines, established with such a de- 
gree of surveillance and rigor that absolute non-inter- 
course is the result, have effectually and without ex- 
ception protected its subjects from yellow fever." 

I have no doubt that the source of the disease, 
the real contagion, is a microscopic organism which 
flourishes about shipping in the ports of hot climates, 
but will not germinate in this region. To borrow an 

* The Association did not indorse this conclusion of the commis- 
sion. Ramon da Luna used fumigations of nitrous acid, and Euro- 
pean authorities assert that no other agent is so effective in pre- 
venting the spread of the disease ("Annales d' Hygiene,". April, 
1861). 



144 MAXIMS OF PUBLIC HEALTH. 

idea, and in part the words, of Dr. William Eoberts, 
in his address before the British Medical Association, 
1877, the yellow-fever virus may be an occasional 
"sport" of some West Indian saprophyte, which by 
variation has acquired a parasitic habit, and having 
run through countless generations either dies out or 
reverts again to its original type. When the varia- 
tion occurs, yellow fever becomes epidemic ; when 
it dies out, or reverts to its original type, yellow fever 



There is evidence that clean towns, even in the 
South, were exempt from the epidemic of 1878. The 
Charleston (South Carolina) delegates to the Public 
Health Association, in a report to the Board of Health 
of their own city, after their return from Eichmond, 
made the following very important statement : " That 
there were local sanitary conditions or climatic in- 
fluences, which in certain instances afforded immu- 
nity from an epidemic, was made apparent, not by 
the commission, but from facts presented by individ- 
ual members of the profession who were present rep- 
resenting towns located in the midst of the infected 
region. The town of Huntsville, Alabama, contain- 
ing five thousand inhabitants, afforded a striking 
illustration of this fact. Its doors were open to refu- 
gees from Memphis and other stricken cities ; quaran- 
tine was entirely disregarded ; the refugees entered 
with their trunks, bedding, and other effects. Out of 
the number of refugees twenty-four sickened with the 
disease after their arrival. These were quartered in 
different portions of the town ; no effort was made to 



MAXIMS OF PUBLIC HEALTH. 145 

isolate them, and yet not a single one of the people 
of Huntsville suffered in consequence. It was ascer- 
tained that this town had some years since suffered 
from epidemic cholera. At that time great energy 
had been manifested, the place was put in thorough 
sanitary condition, and has been so kept ever since. 
No other explanation can be afforded of Huntsville's 
escape from pestilence." 

LXXIII. 

There are degrees in murder. He who assaults a 
strong man and slays him may be entitled to some 
credit for courage. A weak woman may ward off a 
blow, and can cry out for help. The piercing shriek 
of the aged may reach the sympathetic ear of some 
mortal who may render aid. A child, whose hand is 
weak, may utter a sob or moan that will appeal to the 
humanity of all within hearing distance. But he 
who kills a helpless infant in its mother's womb com- 
mits the wickedest of all murders. The little thing 
has no power to resist. It can not even sob, or moan, 
or cry. The very circumstances of its murder indi- 
cate premeditation and dastardly cowardice. The 
mother, near whose heart it nestles, must necessarily 
be an accomplice. It may be that her soul has been 
debauched by the slayer ; it may be that she herself is 
a deliberate murderess. 

Day by day we are appalled at the record of crime. 
Let it not be forgotten that the most important, the 
most vital, the most abiding education any human 



146 MAXIMS OF PUBLIC HEALTH. 

being gets he receives before birth. Every thought, 
every emotion, every impulse of the mother during 
gestation is stamped into the plastic nature of the un- 
born child. Many a woman who lacks the skill, the 
courage, or the money to hire a medical assassin, 
wishes and meditates upon the death of the babe that 
she carries in her womb. Thus the poor thing is al- 
ready educated to murder when it is born. In no 
other way can I account for certain sudden outbreaks 
of homicidal or suicidal impulse in people who are 
apparently sane. It is an awful thing to come un- 
bidden into the world with a fatal taint of parental 
total depravity. 

LXXIV. 

The State, upon the legitimate ground of public 
economy and self-preservation, takes charge of the 
primary education of the people. It therefore deter- 
mines what secular knowledge shall be taught in the 
common schools. It may, and properly should, add 
the simple and ascertained laws of health and public 
hygiene to reading, writing, grammar, geography, 
arithmetic, and history of the country. It is more 
important to children to learn that water from the 
school-house well, only a few feet from the privy, is 
quite as dangerous to them as a mad dog lurking in 
the neighborhood, or that foul air in the unventilated 
school-room is likely to cause their poor mothers 
watchful nights, and may bring dreaded and costly vis- 
itations of the doctor, as it is to learn to cipher, parse, 



MAXIMS OF PUBLIC HEALTH. 147 

name the rivers of Africa, or bound an unknown state 
with unpronounceable name in the center of Asia. 
It touches a good father's pride and makes his dear 
wife happy, to know that their children are improving 
at school ; but health is the incomparable blessing of 
the household, and is more highly prized than learn- 
ing. Give the citizen a plain and sensible reason for 
such teaching, and not a mere professional and mys- 
terious order, and he will not only co-operate with 
the State, but grow more thankful for the enlightened 
government under which he lives. Hence it is pro- 
foundly true that Ave must depend upon the governing 
agency, upon the enactment of wise law and its pru- 
dent administration, for anything like a general dif- 
fusion of sanitary knowledge. It is a disgrace to our 
higher institutions of learning that they are still neg- 
lecting sanitary science. It is a sad sight to see the 
young men and the young women from the first 
American families, at colleges and seminaries, sur- 
rounded with costly appliances for learning all the 
sciences under the sun but the one science that reveals 
to them how to avoid breathing, drinking, even eating 
their own excreta ! 



Nothing so closely concerns political economy, or 
the material welfare of a nation, as the proper sanita- 
tion of the people. It would not be difficult under 
properly co-ordinated and efficiently administered na- 
tional and State sanitary codes to lessen the mortality 



148 MAXIMS OF PUBLIC HEALTH. 

of the people by at least four in the thousand, on 
our population of fifty millions there are more than 
one million of deaths every year. At least two hun- 
dred thousand of these deaths are preventable by sani- 
tation. To turn our eyes from sickness and sorrow, 
from the great sea of heart-ache among the people, and 
to look coldly on the ledger of public prosperity, we 
find that these two hundred thousand preventable 
deaths mean a vast sum of money. For every death 
there are more than twenty cases of sickness. The 
doctor, the apothecary, the undertaker, and grave- 
digger, cost hard cash. The productive industry of a 
sick member of the community ceases during illness. 
The fruitful toil of the dead ceases forever. Skilled 
and reliable workers in statistics cipher out for us that 
each death from preventable disease means, directly 
and indirectly, in the ways here indicated, a loss of 
one thousand dollars. The two hundred thousand 
preventable deaths in the nation every year represent 
an annual public loss of two hundred million dollars. 
Ten per cent of such annual loss would defray the ex- 
pense of carrying out in minute administrative detail 
a complete system of sanitation for the whole country. 
Instead of exaggerating, I purposely make estimates 
that none can dispute. 



It is time for the translation of sanitary science 
into law. This is a new and fertile field for great 
and enlightened statesmen. The people quickly 



MAXIMS OF PUBLIC HEALTH. 149 

learn to appreciate what really brings them good. 
The one guiding principle in such a transition is, that 
only the undisputed conclusions of sanitary science, 
not sanitary theories, should be enacted in a clear 
code, with simple, easily comprehensible, just, impar- 
tial, and economic modes of administration. Clean- 
liness and healthfulness impose few burdens, and en- 
hance the value of everything which they touch. As 
Dr. Eichardson beautifully says: "A change has 
come over the science of medicine ; with nobleness of 
purpose, true Medicine has been the first to strip her- 
self of all mere pretenses to cure, and has stood boldly 
forth to declare, as a higher philosophy, the preven- 
tion of disease. The doctrine of absolute faith in the 
principle of prevention includes the existence of a 
higher order of thought, of broad views on life and 
health, on diseases and their external origin, of death 
and its correct place in nature." 

LXXVII. 

Owing to the peculiar and complex form of our 
government, sanitary law must be dual in form and 
administration while maintaining unity of purpose. 
In other words, we must have a national code and 
State codes. The aim of both will be to increase the 
power and prosperity of the people by enforcing regu- 
lations to protect them from preventable causes of 
sickness and death. We have a few very good mu- 
nicipal sanitary codes, but the statutes of States and 
of the United States contain a very limited number 



150 MAXIMS OF PUBLIC HEALTH. 

of enactments designed to protect the public health. 
We are far behind Great Britain in this respect, where 
special acts of Parliament, for the last quarter of a 
century, have elevated the conclusions of sanitary 
science into the realm of law. The British people 
are already reaping therefrom a rich harvest of prac- 
tical benefit. 



LXXVIII. 

Maritime quarantine ought to be in the hands of 
the Federal Government. There is no constitutional 
reason why the United States should not establish 
maritime quarantine wherever custom-houses are es- 
tablished. Quarantine of any port of entry touches 
the sanitary interests of the whole country. For ex- 
ample, Boston is not a port of Massachusetts alone, 
but of the whole United States. New Orleans is a 
port of the entire country, and not of Louisiana alone. 
Every port at which an infected ship may arrive be- 
longs to the nation. It may not be constitutional for 
the General Government to say to a State that it shall 
not have a quarantine system, but the General Gov- 
ernment has a right to establish its own quarantine 
at any point which is in maritime relation with the 
country at large and with foreign nations. 



An interstate quarantine system could at first be 
only tentative. It would necessarily have to be the 



MAXIMS OF PUBLIC HEALTH. 151 

growth of time and experience — in other words, it 
would finally be shaped, to a great extent, by conflicts 
of State and national laws. The highest judicial tri- 
bunal would settle such conflicts, and make a practi- 
cal system a beneficent reality. The power is clearly 
conveyed in the Constitution to regulate, restrain, or 
prohibit the movement of infected persons and the 
transportation of infected merchandise from State to 
State. Congress has already exercised this power by 
the act of March 3, 1873, "to prevent cruelty to 
animals while in transit by railroad or other means of 
transportation, within the United States." Still more 
reasonably may Congress exercise this power to protect 
the life and health of the people. If the Federal Gov- 
ernment can interfere to prevent cruelty to animals, it 
certainly can interfere to prevent transportation of in- 
fected animals. If it can interfere to prevent suffer- 
ing to a steer, it can interfere to prevent death to a 
man. 

LXXX. 

Every vessel carrying the American flag should be 
under the sanitary supervision of the General Govern- 
ment. Merchant-ships should be required to conform 
to proper regulations for preserving the health of sail- 
ors and passengers. Questions of food, ventilation, 
cleanliness, etc., are just as vital on the water as on 
the land. The Federal Government alone has power 
to enforce sanitary regulations on board ships which 
are registered and sail under its authority. Seamen 
and travelers have a right to be protected, in health 



152 MAXIMS OF PUBLIC HEALTH. 

and life, against ignorance, negligence, and avarice, 
by the nation under whose flag they comuiit them- 
selves to vessels sailing on rivers, lakes, and oceans. 
Frequent inspection by officers empowered to enforce 
sanitary regulations can alone secure such a desirable 
end. 



It is a conceded and well-known fact that various 
articles of manufacture, in common use among the 
people, are adulterated in such a way as to make the 
same dangerous to health and life. Poisonous dyes 
are used to color fabrics worn for clothing. Arsenical 
and lead pigments are wickedly employed to make 
candies look attractive to children. Canned fruits 
and meats are poisoned by lead. Sugars are poisoned 
by muriate of tin used in the process of refining. 
Wall-papers and toys are not unfrequently colored 
with compounds of arsenic. Dangerous drugs are 
used in the manufacture of beers, and in the "doc- 
toring " of wines. But it is not necessary to multiply 
examples. 

With the question of dangerous adulterations of 
various articles of commerce, local health authorities 
are unable to deal in an efficient and comprehensive 
way. Eetail tradesmen are for the most part innocent 
or helpless. The manufacturers are generally to 
blame. They might be reached directly by State au- 
thority ; but Legislatures are reluctant to enact laws 
that would only drive industries to other jurisdictions 
which may be more negligent and apathetic. Indi- 



MAXIMS OF PUBLIC HEALTH. 153 

viduals, beset by universal evils, are quite helpless. 
It requires the power of a nation to cope with a dan- 
ger of such magnitude. 

The General Government, by exercising its consti- 
tutional authority to regulate commerce, can prohibit 
the importation, the exportation, and the interstate 
transportation of all articles which jeopardize the life 
and health of the people. If such articles were made 
by act of Congress liable to seizure in transitu, to 
confiscation and destruction, they would soon cease to 
be manufactured and would disappear from commerce. 
The consignor, the carrier, and the consignee of such 
goods should be penally responsible when proved to 
have criminal knowledge of their character. It might 
not be possible for the National Government to reach 
the manufacturer located within the jurisdiction of a 
State, but it could prevent him from extending his 
murderous trade to the country at large. A single 
seizure of his poisoned goods as soon as they crossed a 
State line and came under the jurisdiction of the na- 
tional authority, would advertise his nefarious business 
to its death. No foreign manufacturer would send 
unwholesome goods to this country if they were liable 
to ignominious destruction after their arrival. Such 
goods would not be manufactured for foreign markets 
if they were liable to inspection, seizure, and destruc- 
tion, before the cargo could obtain clearance. If, 
under international law, poisoned goods designed for 
human use are not contraband of commerce, then 
pirate-ships have a right to sail the seas. 

The manufactures of the nation inaugurating such 



154 MAXIMS OF PUBLIC HEALTH. 

a system would be at a premium throughout the com- 
mercial world. After the first great step had been 
taken by the national power, States would find it easy 
to complete the good work within their own borders. 
The result would be improved commerce, protection 
to life and health, and a reflex education of the peo- 
ple to honest ways. 

LXXXII. 

Tens of thousands of citizens are employed by the 
General Government in its civil service. Federal legis- 
lators, judges, custom-house officers, postmasters, 
heads of departments, and other dignitaries, must 
occupy such buildings as the Government supplies. 
Regiments of clerks, in various places, toil for the 
people in rooms which not unfrequently are ill-ven- 
tilated, badly warmed, overcrowded, or infected with 
the gases of decomposing filth. It is bad economy in 
the nation to subject its servants to unwholesome con- 
ditions. Congressmen, slowly dying with polluted 
air in the Capitol, sometimes utter contemptuous lan- 
guage against public hygiene, while they are trembling 
on the verge of the grave as victims of sanitary apathy. 
Nearly every public building in Washington is a costly 
monument to hygienic negligence, indifference, or ig- 
norance. Many millions have been spent by the Fed- 
eral Government upon imposing structures in other 
cities, which, so far as healthfulness is concerned, are 
a national shame. A bureau, presided over by a sani- 
tarian learned in the difficult science and more diffi- 



MAXIMS OF PUBLIC HEALTH. 155 

cult art of ventilation, and practically skilled in 
wholesome ways of drainage, should have hygienic 
supervision of all national buildings. A nation is not 
wise that allows its laws to be made and administered 
by men whose brains are poisoned with the vapors of 
organic decay. 

LXXXIII. 

It can not be supposed that official investigators 
will supersede great pathologists at the centers of 
science in the civilized portions of the world. Exact 
facts, however, must be collected before the causes of 
epidemics can be fruitfully studied. A powerful gov- 
ernment is the best agent for co-ordinating the efforts 
of individuals, and for extending skilled observation 
to fields beyond the reach of private means. And the 
governing agency alone can apply on a large scale and 
enforce regulations for preventing and arresting epi- 
demics. As Dr. Alfred Carpenter says, in a recent ad- 
dress before the Sanitary Institute of Great Britain : 
"Our domestic animals fall an easy prey to every 
kind of epidemic. . . . We can not remove disease 
from our midst, or reduce our death-rate much below 
seventeen in the one thousand, until we can insure a 
more healthy progeny among our domestic animals." 
Epidemics will not cease among men till they cease 
among the animals on which men feed. It will re- 
quire the heavy hand of the Federal Government to 
suppress the national traffic in diseased animals and 
unwholesome meats. 



156 MAXIMS OF PUBLIC HEALTH. 

LXXXIV. 

Hand in hand with the prudent administration of 
a wise sanitary code, must go on the work of the hy- 
gienic education of the people. Lord Derby, speak- 
ing from ripe experience in the government of an in- 
dependent people, truly says : "No sanitary improve- 
ment worth the name will be effective, whatever acts 
you pass, or whatever powers you confer upon public 
officers, unless you can create an intelligent interest 
in the matter among the people at large. The state 
may issue directions, municipal authorities may exe- 
cute to the best of their power, inspectors may travel 
about, medical authorities may draw up reports, but 
you can not make a population cleanly or healthy 
against their will, or without their intelligent co-op- 
eration. This is why, of the two, sanitary instruction 
is even more important than sanitary legislation." 

LXXXV. 

A State Legislature is supreme, except in such mat- 
ters as have been delegated by the Constitution to the 
National Government. The provisions of a State sani- 
tary code may, therefore, be as extensive as protection 
to the public health may require. Good sense, rea- 
sonable prudence, and exact hygienic science, are the 
only things that the Legislature needs to consult. 
Experience proves that the people are always ready to 
sustain measures that promote the general welfare. 
The public never complains of reasonable sanitary 



MAXIMS OF PUBLIC HEALTH. 157 

regulations. On the contrary, complaints are loud, 
and sometimes threatening, when nuisances are neg- 
lected and epidemics are left to multiply their vic- 
tims. Show the people a sensible way of shielding 
themselves against things that disturb their comfort, 
injure their health, and threaten their lives, and they 
will heartily and promptly bestow the authority, and 
contribute the means of securing a desirable end. 



An elaborate measure to protect the people of the 
State against pretenders to medical knowledge and 
surgical skill is not desired by a majority of the more 
thoughtful members of the profession. Neither is 
such a measure desired by the people. If a citizen 
wishes to be physicked and have his broken bones set 
by a quack, the State may act wisely in not interfer- 
ing ; but the assumption of the title "doctor" by a 
quack may deceive the citizen, may lead the citizen 
to employ the quack without knowing that he is such, 
and should therefore be prohibited. People in haste 
for a physician frequently stop at the first sign pro- 
claiming that a Dr., or an M. D., has his office with- 
in. It is the duty of the governing agency to see that 
no false signs of that kind are hung out. The British 
registration law of 1858 is based on the sound prin- 
ciple that "it is expedient that persons requiring 
medical aid should be enabled to distinguish qualified 
from unqualified practitioners." Compel the quack 
to announce to an afflicted world that Mr. So-and-so 



158 MAXIMS OF PUBLIC HEALTH. 

bleeds, pukes, purges, cuts off legs, sets bones, rubs, 
magnetizes, sweats, etc., and thus prohibit him from 
deceiving those who are in quest of a real doctor. If 
people knowingly prefer the quack, let them have 
him. The quack, like the regular practitioner, should 
also be held strictly accountable to the law of mal- 
practice. When the quack is denied the right to en- 
force the collection of his fees, is prohibited from tes- 
tifying as an expert, is forbidden to proclaim himself, 
by any device whatsoever, as a doctor, and is civilly 
and criminally held responsible for doing his work 
with the average knowledge and skill of the profession 
in his neighborhood, then let him take his crooked 
chance in* the world. He may at least be of some use 
as a fool-killer. 



The Government of England, beginning more 
than a quarter of a century ago, has enacted the un- 
disputed conclusions of sanitary science into law. 
For this reason, the hygienic condition of England is 
superior to that of any other country. In this coun- 
try there is very little administration of sanitary law, 
except in the leading cities. The people of these 
cities have experienced the benefits, and would not, 
if they could, go back to the almost fruitless days of 
mere sanitary teaching and preaching. They are not 
satisfied with talk about public health, but demand 
that something should be perpetually done to protect 
it. No community can live by preaching alone. The 



MAXIMS OF PUBLIC HEALTH. 159 

morality, the sense of justice, that is born of public 
teaching, must be embodied in jurisprudence, must 
be translated into law to be enforced by the aggre- 
gate power of organized society. Whatever will not 
bear such a transformation at the hands of the legis- 
lator is wanting either in definiteness or in reality. 

The reason for carrying the conclusions of sound 
sanitary science up into the crucial region of admin- 
istered law is not far to seek. The author of the 
health primer entitled "Premature Death" says, in 
golden words : "In dealing with the personal care of 
health, it has become customary to treat of man as if 
he were an abstract personage, capable of procuring 
for himself, and doing for himself, all that was neces- 
sary for the maintenance of his corporeal and mental 
well-being ; he is taught the qualities of good and of 
bad air, of good and of bad water, of the requirements 
of wholesome houses, of the characteristics of health- 
ful food, of the due regulation of exercise and habits. 
He is taught all these things, not as vague generali- 
ties, but as matters of precise knowledge which in- 
volve a high degree of moral responsibility in their 
application. All this is an essential part in the great 
process of health-education now going on, and is pro- 
ducing excellent and progressively increasing results. 
But this teaching has been, and is still, too much dis- 
sociated from the actual facts of the circumstances 
under which man lives in a civilized country. The 
vast majority of individuals are dependent for the sort 
of air they breathe, the water they drink, the homes 
they inhabit, the food they consume, the opportuni- 



160 MAXIMS OF PUBLIC HEALTH. 

ties of relaxation they may have, and even of the 
habits they form, upon others, and they can bring 
to bear but an infinitesimal influence over these all- 
important elements of their physical welfare. How 
many of us can exercise the slightest control over the 
qualities of the water we drink, or of the air we 
breathe, the construction of the houses we inhabit, 
the quality of the food we have to eat, or our physical 
habits ? We are, for the most part, the slaves of our 
purse and our occupation, and unable to help our- 
selves in these matters, except as we act together as a 
community. It is at this point where our ordinary 
health-teaching mainly fails, namely, in neglecting to 
show the circumstances under which individuals can 
only obtain sanitary essentials by conjoint action, as 
a community, and to what extent and in what mat- 
ters the Legislature has made provision for such con- 
joint action. The chief impediment to sanitary prog- 
ress at this moment is the want of a just knowledge 
of the relations of the community to sanitary work, 
and the consequent misapprehensions of individuals 
and the insensitiveness of communities on this subject. 
What is now mainly wanted, in view of the further- 
ance of sanitary work, is an acuter sense among indi- 
viduals generally of their common rights and common 
powers in sanitary matters. " 

The only way to bring to bear the power of the 
community for the benefit of its individual members 
is by the enactment and administration of law. 



MAXIMS OF PUBLIG HEALTH. 161 



LXXXVIII. 

Drinking-water, like Caesar's wife and boiled eggs, 
should not only be good but above suspicion. Water 
constitutes nearly three fourths of the weight of the 
human body. "Water," says Professor Huxley, 
"gives fullness and flexibility to the softer tissues, 
and is the great agent of movement within the sys- 
tem. It performs the same office of transportation 
and exchange in the vital economy that it does by 
oceans, rivers, and canals, in the commerce of the 
world. Nutritive substances can not enter the sys- 
tem, nor the debris of the tissues leave it, except in a 
state of solution ; it is the office of water to bring 
them into this condition, and to convey them to their 
various places of destination." High authorities at- 
tribute one third of the diseases that afflict humanity 
to the use of impure water. Dr. Parkes, at the close 
of a long discussion on the deleterious effects of im- 
pure drinking-water, comes to the following general 
conclusions : 

" 1. An endemic of diarrhoea in a community is 
almost always owing either to impure air, impure 
water, or bad food. If it affects a number of persons 
suddenly, it is probably owing to one of the last two 
causes, and, if it extends over many families, almost 
certainly to water. But as the cause of impurity 
may be transient, it is not always easy to find experi- 
mental proof. 

" 2. Diarrhoea or dysentery constantly affecting a 
community, or returning periodically at certain times 



162 MAXIMS OF PUBLIC HEALTH. 

of the year, is far more likely to be produced by water 
than by any other cause. 

"3. A very sudden and localized outbreak of 
either typhoid fever or cholera is almost certainly 
owing to introduction of the poison by water. 

"4. The same fact holds good in cases of malari- 
ous fever, and, especially if the cases are very grave, 
a possible introduction by water should be carefully 
inquired into. 

" 5. The introduction of the ova of certain ento- 
zoa by means of water is proved in some cases, is 
probable in others." 

LXXXIX. 

Vital statistics are still of great value after all pos- 
sible deductions are made on account of inaccuracies. 
Careless physicians and ignorant quacks will return, 
under proper pressure of law, at least the whole num- 
ber of deaths, with statements of age, sex, and nativity. 
The average mortality of a community, with its more 
obvious conditions, may thus be determined with pre- 
cision. It is not necessary to dwell upon the impor- 
tance of a reliable death-rate. And it so happens that 
the diseases which are most influenced by sanitary ad- 
ministration are easily recognized. A death from 
small-pox is ne^er attributed to any other cause. 
Nearly every mother of a family knows scarlet fever 
as well as the doctor. Diagnosis of diphtheria baffles 
few except those perverse or wicked practitioners who 
wish to avoid reporting it to the health authority. 



MAXIMS OF PUBLIC HEALTH. 163 

Consumption is sadly familiar in most households, 
and its presence is known without the intervention of 
a learned pathologist. Eemote causes of premature 
death may he beyond the ken of the medical layman 
and the ordinary doctor, but it is not necessary to 
throw away vital statistics because they are not per- 
fect. It would be unwise to throw away all statutes 
because legislation has not reached an ideal standard. 
Science should not be abandoned because it has not 
explored all the secrets of nature. There is much 
that is extremely valuable in vital statistics, although 
the defects in returns of the causes of mortality wring 
words of regret and impatience from the wisest and 
best sanitarians. 



It is well enough in this country to take cogni- 
zance of what is regarded in Great Britain as the proper 
education of a health-officer. The requirements of 
the University of Edinburgh do not differ from the 
requirements of other institutions of learning in the 
kingdom, and are as follows : Bachelor of Science. — 
1. The candidate must be a graduate in medicine of 
a British university, or of such colonial, Indian, or 
foreign university as may be specially recognized by 
the University Court. 2. He must be matriculated 
for the year in which he appears for examination. 3. 
If the candidate have not passed an annus medicus in 
the University of Edinburgh, he must, before present- 
ing himself for examination, have attended in the 



164 MAXIMS OF PUBLIC HEALTH. 

university at least two courses of instruction., scien- 
tific or professional, bearing on the subjects of the ex- 
aminations. 4. There are two examinations for the 
degree of Bachelor of Science in the Department of 
Public Health. A candidate who has passed the first 
examination may proceed to the second at the next 
period fixed for this, or at any subsequent examina- 
tion. 5. The candidate must produce evidence that, 
either during his medical studies or subsequently, he 
has attended a course of lectures in which instruction 
was given on public health ; and that he has studied 
analytical chemistry practically for three months with 
a recognized teacher. 6. The examinations are writ- 
ten, oral, and practical, and are conducted by univer- 
sity examiners selected by the University Court. 7. 
The subjects of the examination for the degree of 
Bachelor of Science in the Department of Public 
Health are as follows : 

First Examination. — 1. Chemistry. — Analysis of 
air, detection of gaseous emanations and other impuri- 
ties in the atmosphere ; analysis of water for domestic 
use, and determination of the nature and amount of its 
mineral and organic constituents ; detection, chemical 
and microscopical, of adulteration in articles of food 
and drink, and in drugs ; practical examination, in- 
cluding at least two analytical researches. 2. Physics. 
— Hydraulics and hydrostatics, in reference to water- 
supply, drainage, and sewerage ; pneumatics, in rela- 
tion to warming and ventilation ; meteorological ob- 
servations ; mensuration, in reference to the plans and 
sections of public and private buildings, mines, water- 



MAXIMS OF PUBLIC HEALTH. 165 

works, and sewers. The candidate must make figured 
sketches of models. 3. Sanitary Law. — Knowledge 
of the leading sanitary acts of Parliament. 4. Vital 
Statistics. — Knowledge of statistical methods and 
data in reference to population, births, marriages, and 
deaths. An oral examination, and an examination in 
practical chemistry in the laboratory, will take place 
a few days after the written examination. 

Second Examination. — 1. Medicine. — Origin, na- 
ture, and propagation of epidemics and contagious 
diseases ; prevention of contagion and infection ; en- 
demic diseases, and the geographical distribution of 
disease ; insalubrious trades ; overcrowding, epizootics, 
including pathological changes. 2. Practical Sanita- 
tion. — Duties of a health-officer in reference to water- 
supply ; insalubrious dwellings and public buildings ; 
removal and disposal of sewage and other refuse 
and impurities, cemeteries, nuisances from manufac- 
tories, etc. ; bad or insufficient supplies of food ; out- 
breaks of zymotic diseases ; quarantine ; disinfect- 
ants and deodorizers ; construction of permanent and 
temporary hospitals. 

Doctor of Science. — A Bachelor of Science in the 
Department of Public Health may, after the lapse of 
one year, proceed to the degree of Doctor in the same 
department, on producing evidence that he has been 
engaged in practical sanitation since he received the 
degree of Bachelor of Science, and on producing a 
thesis on some subject embraced in the Department of 
Public Health. Every such thesis must be certified 
by the candidate to have been composed by himself, 



166 MAXIMS OF PUBLIC HEALTH. 

and must be approved by the examiners. The candi- 
date for the degree of D. Sc. must lodge his thesis 
with the Dean of the Medical Faculty on or before 
January 31st, in the year in which he proposes to 
graduate. No thesis will be approved which does not 
contain either the results of original observations on 
some subject embraced in the examination for B. Sc, 
or else a full digest and critical exposition of the opin- 
ions and researches of others on the subject selected 
by the candidate, accompanied by precise references 
to the publications quoted. 

The following are recommended as books to be 
studied in preparation for the above examinations : 
Parkes, E., "Practical Hygiene"; Wilson, George, 
"Hand-Book of Hygiene"; Smith, Edward, "Man- 
ual for Public Officers of Health " and " Hand-Book 
for Inspectors of Nuisances " ; Michael, Corfield, and 
Wanklyn, "Manual of Public Health," edited by E. 
Hart ; Eassie, " Healthy Houses " ; Latham, Baldwin, 
" Sanitary Engineering " ; Law, Henry, "Eudiments 
of Civil Engineering" ; Monro, George, "The Public 
Health Act"; Buchan, Alexander, "Introductory 
Text-Book of Meteorology." 

Seventeen out of the twenty great universities of 
Germany are now giving courses of instruction in 
state medicine. The medical schools of the United 
States are sadly behind the times in neglecting to 
teach hygiene. 

However well trained a health-officer may be, he 
must deal hard blows, not only to secure any advance- 
ment in sanitary work, but even to maintain the dig- 



MAXIMS OF PUBLIC HEALTH. 167 

nity of his position against traditional prejudice and 
conceited presumption. As Dr. Billings sarcastically 
says: "Among architects, engineers, lawyers, and 
politicians, a feeling is very common that the sanita- 
rian should confine himself to the pointing out of the 
evils to be remedied ; that he should be a sort of in- 
spector of nuisances, with sufficient knowledge of 
medicine to give a name to the evil results observed, 
and that he should leave to them, with their special 
and superior knowledge, the task of remedying these 
evils. This plan has been very thoroughly tried, and 
the results are not satisfactory — in fact, the preva- 
lence of this idea has been one of the causes of the slow 
progress of hygiene." 



APPENDIX 



When the chapter on cholera in this book was 
written, Dr. Koch had not yet returned from India, 
and the results of his investigations were unknown. 
The yery remarkable paper, read recently before a se- 
lect audience of scientists at Berlin by Dr. Koch, is 
too long and too exclusively addressed to the profes- 
sion to be inserted here. In the opinion of Professor 
Virchow and of other competent judges, the paper of 
Dr. Koch marks the beginning of a new epoch in the 
history of cholera. In order to give readers some no- 
tion of the discovery and views of Dr. Koch, I repro- 
duce here the following clear and accurate summary 
from the " British Medical Journal " : 

" Of course, the whole point turns on whether Dr. 
Koch has made out that the comma-bacillus is really 
the cause of the disease. In order to demonstrate 
that a given bacterium is the cause of a disease, it 
must be proved — 1. That a special bacterium, with 
definite characteristics marking it out from other 
forms of bacteria, is constantly present in the parts 
affected ; 2. That this bacterium is present in suffi- 
cient numbers to account for the disease ; 3. That it 
is not similarly associated with other diseases ; 4. 
That this bacterium can be cultivated apart from the 
body, and that its introduction into the lower animals 



170 APPENDIX. 

is followed by the same effects as the introduction of 
the infective material itself. With regard to the first, 
second, and third points, Dr. Koch gives a definite 
and perfectly satisfactory answer. He finds a bacillus 
(the comma-bacillus) constantly present in the af- 
fected parts (the intestinal tract), and always in suffi- 
cient numbers to account for the disease. This bacil- 
lus has definite characteristics which mark it out from 
all other known bacteria. It is not so much by its 
form and microscopical appearances that it is to be 
distinguished, as by its mode of growth in cultivating- 
materials rendered solid by the addition of gelatine. 
This is a point which requires the most careful atten- 
tion by those who will, no doubt, engage in control- 
observations. Dr. Koch has failed to find in other 
diseases micro-organisms presenting all the charac- 
teristics of the cholera-bacillus ; but, no doubt, organ- 
isms of a curved shape, presenting the microscopical 
appearances of the comma-bacillus, will be found in 
fseces and other materials. It does not, however, fol- 
low that it is the organism described by Koch in con- 
nection with cholera. Before this can be stated it 
must be cultivated, and its cultivation in gelatinized 
materials must show the appearances described by 
Koch. 

" The answer to the fourth point is what it ought 
to be, though it is not satisfactory. The introduc- 
tion of the comma-bacillus into the lower animals is 
followed by the same result as the introduction of the 
infected material itself (fseces), the effect in most in- 
stances being none. This result is, of course, unsat- 



APPENDIX. 171 

isfactory in one way, "because, till an animal is found 
which will take cholera, the absolute proof that the 
comma-bacillus is the cause of cholera can not be fur- 
nished ; but the result is satisfactory, in that in this 
point also the comma-bacillus agrees in its action with 
cholera-stools. Had the comma-bacillus produced dis- 
ease where cholera- virus did not, the idea that the com- 
ma-bacillus is the virus of cholera would, of course, 
be untenable. 

" The question is, whether this evidence is suffi- 
cient to show that the comma-bacillus is the cause of 
cholera or not. Standing by itself, it is undoubtedly 
insufficient ; but when considered in connection with 
known facts with regard to other infective diseases, 
the view becomes highly probable, and, no doubt, al- 
most certain to most of those who are thoroughly ac- 
quainted with these researches. In every single in- 
stance in which infective diseases have been found to 
be communicable from animal to animal, it has been 
demonstrated that, when micro-organisms are con- 
stantly present at the seat of the disease in sufficient 
numbers to account for the disease possessing definite 
characteristics marking them out from other micro- 
organisms, and not present in other diseases, these 
micro-organisms are undoubtedly the cause of the dis- 
ease. 

"In the diseases not communicable to the lower 
animals (typhoid fever, leprosy, etc.), few who have 
studied them doubt that the special organisms found 
in them are the true cause ; and why should this doubt 
be greater in cholera than in other instances ? Koch 



172 APPENDIX. 

looks on the experiments made by Bichards, and which 
have been brought forward by some writers in opposi- 
tion to Koch, as in reality in favor of his views on 
the etiology of cholera, as showing that the comma- 
bacilli produce a toxic substance in the intestinal 
canal. 

" The facts which Koch has made out with regard 
to the rapid death of the bacilli on drying are, ac- 
cording to him, in accordance with many known facts 
on the spread of cholera. Whether there may not be 
a permanent or spore condition is a point which can 
not, however, be regarded as settled by his experi- 
ments. Various facts seem to point to the existence 
of spores — among others the passage of the bacillus 
through the gastric juice without sustaining injury. 

"Dr. Koch hopes that the presence of the comma- 
bacillus may be of service in diagnosing Asiatic chol- 
era, more especially in the early cases, in any given 
place. For this diagnosis, however, cultivation-ex- 
periments are indispensable, and few have either the 
knowledge or the conveniences to enable them to 
carry this out. No doubt, should Koch's experiments 
be confirmed, some steps will be taken, in places 
threatened with an epidemic, to have means at hand 
for the satisfactory and rapid determination of the 
diseases in suspicious cases. At the present time, if 
the discharges from suspicious cases were forwarded 
for examination to those who are interested in this 
work, much useful knowledge might be gained, and 
early intimation of the existence of the disease be 
obtained." 



INDEX. 



Abattoir, sanitary need of, 89, 93. 
constitutionality of law to estab- 
lish, 97. 

Acetic acid as a disinfectant, 86. 

Acton, his book on sexual disor- 
ders, 65. 

Administration of sanitary law, 
158. 

Adulteration of foods and drinks, 
98. 
should be dealt with by the Na- 
tional Government, 152. 

Aitken ; Dr. W., on communica- 
bihty of cholera by water and 
food, 119. 

Alcohol, Dr. Parkes on use of, 62. 

Animals, torture of, in transit, 94. 

Babies killed by kissing, 83. 

Bacillus anthracis, 27. 
subtilis, 32. 

Backhouse, 26. 

Bain, Alexander, on the moral 
sense, 15. 

Beneden, Professor Van, on trichi- 
nae, 35. 

Bergh, Henry, on wounded beef- 
cattle, 95. 

Billings, Dr., defense of the sani- 
tarian, 167. 

Bishop on protection of the pub- 
lic health, 68, 69. 

Boardman, Dr., on public loss 
from preventable disease, 9. 

Boiling, to disinfect, 84. 

Bowditch, Dr., on wetness of soil, 
25. 

Bretonneau on diphtheria, 132. 



Buchanan, Dr., 

25. 
Burdon - Sanderson on contagia, 

58. 
Burke, not so bad as a wicked 

doctor, 83. 
Butchering-places, 59. 
Butler, General, banished yellow 

fever from New Orleans, 140. 

Calvin, John, in Geneva plague, 

64. 
Carlyle, Thomas, on gin, 62. 
Carpenter, Dr. Alfred, on the dan- 
gers of unhealthy animals for 
food, 155. 
Chadwick, appeal of, 82. 

maxims of sanitation, 88. 
Chaumont, Dr. De, on ozone, 19. 
Chemist, organized matter beyond 

ken of, 10. 
Chinese, their method of dispos- 
ing of filth, 22. 
Cholera, 5. 
described, 110. 
spread of, 111. 
cause of, 116. 
how communicable, 119. 
prevention of, 123, et seq. 
Conn, Professor, on bacilli, 32. 
Congress has made a law to protect 

animals in transit, 151. 
Conscience, public sanitary, 15. 
Contagium vivum, 57. 
Contagious diseases, responsibility 
in, 69. 
Judge Dixon's opinion, 70, 
' 72. 



174 



INDEX. 



Contagious diseases, reporting of, 
by doctors to sanitary author- 
ity, 74. 
diffusion of, 74. 

Cooley, Judge, on law of abattoirs, 
97. 

Cruelty to animals, 92, et seq. 

" Dairies," 34. 

Dampness of soil favors diseases, 
55. 

Darwin, 31. 

Davis, Dr., bis " Hvgiene for 
Girls," 67. 

De novo origin of disease, 33. 

Derby, Lord, on tbe necessity of 
sanitary teaching as a pre- 
paration for sanitary law, 
156. _ 

Diphtheria, 5. 
described, 131. 
known to the ancients, 132. 
contagiousness of, 134. 

Disease, costliness of, 9. 
disseminated by filth, 52. 

Disinfectants, 83. 

Dougal, Professor John, on disin- 
tectants, 87. 

Dowell, Dr. Greeneville, on yel- 
low fever, 141. 

Drainage, 25. 

Drainage system, separate, 49. 

Dram-drinking, its cost, 61. 

Drinking-water a medium for con- 
veying cholera, 119, 121. 
like Csesar's wife and eggs, must 
be above suspicion, 161. 

Economy of sanitation, 147. 

Education, why it should be un- 
dertaken by the state, 146. 

Emerson on washed sinners and 
dirty saints, 15. 

England, sanitary advancement 
of, 158. 

Enteric fever, 137. 

Enteroid fever, 137. 

Epidemic diseases, 5. 

Eucalyptus as scavenger, 29. 

Excrement from skin, 14, 23. 

Expenditure of dram-drinking, 
61. 



Farr, Dr., on reducing mortality 

by sanitation, 10. 
Ferments vs. living germs, 58. 
Filth, 6, 7. 

in garments, 14. 

source of diseasej 52. 
Fire the best of disinfectants, 84. 
Flies as purveyors of disease, 39. 
Flushing, 40. 

Franklin, his health aphorism crit- 
icised, 20. 
Free-love and cesspools, 40. 

Gamgee, Professor, on diseases of 
cattle, 90. 

Garbage, disposal of, 43. 

Geneva, plague at, 63. 

Germs, 42. 
living vs. dead ferments, 58. 

Gin, Carlyle on use of, 63. 

Girls, dangers of, 66. 

Government should undertake 
costly investigations of epi- 
demics, 155. 

Grassi, Dr. B., on danger from 
flies, 39. 

Great Britain ahead of us in sani- 
tation, 150. 

Health-officer, education of, 163. 
Heat as destroyer of germs, 28. 
Hippocrates, health formula of, 

13. 
House, outer garment of life, 17. 
Huxley, Professor, on water, 161. 
" Hygiene for Girls," 67. 

Ice, impurities of, 105. 
Ingersoll, Eobert, on Moses, 13. 
Inspection of meat, 89. 
Iphigenia, tragedy of, 67. 

Kiss, children killed by, 135. 
Koch, Dr., on cholera, Appendix. 
Kolokotrones on filthy garments, 
14. 

La Eoche, Dr., on yellow fever, 
139, 140. 

Law, sanitary, the practical con- 
summation of sanitary science, 
148. 



INDEX. 



175 



Law, must be dual in form — State 
and national, 149. 
must be preceded, by sanitary 
teaching, 156. 
Lebert, Professor H., history of 
cholera epidemics, 113. 
on cholera-germs, 118. 

Macnamara, Dr. C, his descrip- 
tion of an attack of cholera, 
114. 
on communicabihty of cholera, 
119. 
Malaria, 25, 41 note. 
Matter, organic and organized, 10. 

forms of, 20. 
Meat, inspection of, 89. 

diseases of, 90. 
Meat-markets, 60. 
Medical education, 157. 
Midwives, 16. 
Milk, 33. 
Moses, hygienic precepts of, 13. 

sanitary texts from, 81. 
Municipal corporations, responsi- 
bility of, for nuisances, 56. 
Murder of the unborn, 145. 

Nichol, Professor "William E., on 

impurities of ice, 108. 
Nurse, a model one, 82. 

Organic matter differentiated from 

organized, 10. 
Oxygen, Nature's disinfectant, 18. 
Ozone, as purifier, 19. 

Pan-closet, a nuisance, 41. 
Parasites, 27. 

Parkes, Dr., on costliness of dis- 
ease, 9. 
on use of alcohol, 62. 
on water as medium of convey- 
ing cholera, 121. 
on impure drinking-water, 161. 
People, the, always ready to sus- 
tain reasonable measures, 156. 
Personal liberty, 63. 

to infect a church, 79. 
Pest-house, 80. 
little danger of, to vaccinated in- 
mates, 108. 



Physicians sometimes carelessly 

spread contagious diseases, 83. 
Placarding for contagious disease. - 

70. 
advantages of, 79. 
Plague, 4. 
Plants, as destroyers of bacteria, 

29. 
Playfair, statistics of disease and 

death, 9. 
Poisons, forms of, 20. 
Preaching, sanitary, is not alone 

sufficient, 158. 
Prevention of infectious 



Public buildings need sanitary 

supervision, 154. 
Putrefaction, 23. 
hygiene of, 51. 

Quack, of use as a fool-killer, 158. 
Quarantine, 30. 

maritime, belongs to nation, 150. 

interstate, 150. 

Eabelais, sarcasm of, applied to 

midwives, 16. 
Eainfall, amount of, on a city, 54. 
Eed Cross, sanitary order of, 82. 
Eefuse, organic, disposal of and 

amount of, 43. 
Eeporting contagious diseases to 

the sanitary authority, advan- 
tages of, 76. 
difficulties of, 78. 
Eichardson, Dr. B. W., on conta- 

gia, 57. 
on preventive medicine, 149. 
Eoberts, Dr., on parasitic origin of 

disease, 31. 
Bush, Dr., on responsibility of 

government for not preventing 

levers, 59. 

Sanitary education should be un- 
dertaken by the state, 146. 

Saracens practiced temperance and 
cleanliness, 13. 

Scarlet fever, 127, et seg. 

Schools, cost of educating children 
at, increased by bad hygiene, 
12. 



176 



INDEX. 



Science, sanitary, should be trans- 
lated into law, 148. 

Seminal weakness, doctors of, 64. 

Separate system of sewering, 49. 

Sewage, measured by water-sup- 
ply, 45. 

Sewer-gas, 7, 41. 

Sewer system, 44. 

Simon, John, on the two great 
sanitary evils, 3. 
on restriction of contagia, 71. 

Slaughtering, 58. 

Slaughtering-mask, 93. 

Slaughtering-places, objections to, 

Small-pox, 5. 

how to prevent, 99. 
Stables, 23. 

State, the, guardian of public 
health, 13. 

reasons for its undertaking the 
education of the people, 146. 
Statistics, vital, 162. 
Storm-water, removal of, 53. 
Sulphur, as a disinfectant, 84. 

Teaching, sanitary, must be sup- 
plemented by sanitary law, 
159. 

Tomkins, Dr. Henry, on vaccina- 
tion, 109. 

Trichinae, 35, et seq. 



Tyndall, Professor, 28. 

on contagia, 58. 
Typhoid fever, 137. 
Typhus fever, 5, 137. 

Vaccination, 99, et seq. 
Vaughan, Professor, on partial pu- 
rification by freezing, 108. 
Ventilation of house, 17. 
Vinegar, as a disinfectant, 86. 

of the four thieves, 86. 
Voluntary effort in sanitation, 



Waring, Colonel, 28. 
Wastes, organic, 6. 

disposal of, 44. 
Water-closet, how to choose, 41. 
Water-drainage system, 46. 
Wells, dangers of, 21. 
of soil, 25. 



Wolsey, Cardinal, protected him- 
seli against the infected crowd 
by vinegar in a sponge, 86. 

Wood, on slaughter-house nui- 
sance, 97. 

Wood and Formad, conclusions of, 
as to the micrococci of diph- 
theria, 132. 

Yellow fever, 5. 
account of, 138, et seq. 



HEALTH BOOKS. 



Health Primers. Edited by J. Langdon Down, M. D., F. R. C. P. ; 
Henry Power, M. B., P. R. 0. S. ; J. Mortimer-Granville, M. D. ; 
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I. Exercise and Training. 
II. Alcohol: Its Use and Abuse. 
III. Premature Death: Its Promo- 
tion or Prevention. 
rv. The House and its Surround- 
ings. 



VI. 

VII. 

vni. 

IX. 



Personal Appearance in 

Health and Disease. 
Baths and Bathing. 
The Skin and its Troubles. 
The Heart and its Puno- 
The Nervous System, [tions. 



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HEALTH BO OKS.— (Continued.) 



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THE POPULAR SCIENCE MONTHLY. 

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